Volume 4, Issue 3, Pages (March 2019)

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Presentation transcript:

Volume 4, Issue 3, Pages 136-139 (March 2019) Endoscopic en bloc removal of appendiceal polyp facilitated by traction Sergey V. Kantsevoy, MD, PhD, Avesh J. Thuluvath, MD, Amit Raina, MD, Paul J. Thuluvath, MD VideoGIE Volume 4, Issue 3, Pages 136-139 (March 2019) DOI: 10.1016/j.vgie.2018.11.009 Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 DiLumen double-balloon interventional platform consists of the following elements: A, Plastic sleeve serves as an overtube around the endoscope. B, Aft-balloon is attached to the oral (proximal) end of the sleeve. C, Fore-balloon is attached to the oral end of the sleeve by 2 pushrods. D, Base is attached to the anal (distal) end of the sleeve. E, Slider knob for the fore-balloon. Sliding this knob forward moves the fore-balloon in the oral direction (away from the sleeve). Pulling the knob backward pulls the fore-balloon in the anal direction (toward the sleeve). F, Inflation handle is used to selectively inflate or deflate each balloon. VideoGIE 2019 4, 136-139DOI: (10.1016/j.vgie.2018.11.009) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 Schematic diagram demonstrating consecutive procedural steps: A, Polyp originating inside the appendix. B, A PolyLoop is tightened around the polyp and connected to the fore-balloon of the DiLumen. The fore-balloon is retracted in the anal direction, pulling the polyp into the cecum and exposing the attachment of the polyp to the appendiceal mucosa. C, Submucosal injection of normal saline solution under the polyp with endoscopic injection needle. D, The polyp is cut off from the site of its attachment. E, The polyp is removed. F, Mucosal defect after lesion removal is closed with 1 continuous endoscopic suture with the Overstitch endoscopic suturing device. VideoGIE 2019 4, 136-139DOI: (10.1016/j.vgie.2018.11.009) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 Adenomatous polyp growing from appendix into cecum. VideoGIE 2019 4, 136-139DOI: (10.1016/j.vgie.2018.11.009) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 The Polyloop is tightened around the appendiceal polyp. VideoGIE 2019 4, 136-139DOI: (10.1016/j.vgie.2018.11.009) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 5 The PolyLoop is attached to the fore-balloon of the DiLumen with endoscopic clip. VideoGIE 2019 4, 136-139DOI: (10.1016/j.vgie.2018.11.009) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 6 The fore-balloon is retracted in the anal direction, pulling the polyp into the cecum and exposing the attachment of the polyp to the appendiceal mucosa. VideoGIE 2019 4, 136-139DOI: (10.1016/j.vgie.2018.11.009) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 7 Submucosal injection of normal saline solution under the polyp. VideoGIE 2019 4, 136-139DOI: (10.1016/j.vgie.2018.11.009) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 8 The polyp is cut off with the DualKnife. VideoGIE 2019 4, 136-139DOI: (10.1016/j.vgie.2018.11.009) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 9 Specimen demonstrating 15-mm polyp after en bloc removal, with clearly visible normal mucosal resection margin. VideoGIE 2019 4, 136-139DOI: (10.1016/j.vgie.2018.11.009) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 10 Mucosal defect after lesion removal is closed with 1 continuous endoscopic suture using Overstitch endoscopic suturing device. VideoGIE 2019 4, 136-139DOI: (10.1016/j.vgie.2018.11.009) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions