Right Colon ESD can be a long and challenging procedure without traction. In this video Dr. Molham Abdulsamad of Geisinger Health demonstrates how Lumendi’s DiLumen™ C1 overtube and IgE Grasper improve access, stability and provide independent, multidirectional traction during resection of an ascending colon polyp adjacent to the hepatic flexure.
In this case, she's a young patient who had a screening colonoscopy and found to have an advanced looking lesion which looks dysplastic and in the ascending colon. It was biopsied and it showed high grade dysplasia. It's probably early. May have some early malignant features. So I think in this scenario it is very important to get a complete resection, R0 resection, to get all negative margins and get the get the lesion in block, not piecemeal, so you get the best outcome for the patient. All right, so ascending towards hepatic flexure, descent, not cancer. And like we said, Definitely advanced spit pattern. But not that much. I thought they were worried. I think it came back high grade dysplasia already, so we're going to have to make sure we aim for an in-block resection. The tattoo is actually almost going there, almost infiltrating it. I hope it's a little dark here. I hope there is no tattoo going all the way. But hey, if it is, you know, the traction will help. Decent size. OK. So the aluminate the C1. It's ready, lubricated. And the grasper sheet is ready. Let's go. All right. Again, I'll advance around 50. And then I'll start sliding the balloon over. So that's probably splenic flexure. And now I'm sliding the tube. Gently over the scope. Until I see it all the way here. Again, if it doesn't advance, you have to stop. If you feel resistance, go back and see what's going on. So far it's sliding nicely. So inflate, let's inflate. All right, balloon is inflated. Reduce back a little bit. Hold from here. And I'm going to advance my school. Excellent. All right. So now I'm in the transverse colon towards the polyp, deflate the balloon, and we're going to slide all the way to the polyp. Here is the balloon. Hold the device for a minute. Going to inflate. Let go. Let me shorten. OK, that's nice. Hold this for a minute. All right, that's good. Now, let's get position for traction. I'd like to go beyond the lesion. I'm going to deflate, hold the device. Let me go in. All right, let's go. Keep it, keep it, it's OK. 4 by 4. Hold the device. All right. Set up for the grasper. So same, same principle, we push the balloon further in, deep into the lumen, we see where the grasper is coming, and it's coming from the 5 o'clock. OK, lubricated and ready. The jaws are closed. We're gonna advance. Did we fall? Nope, we're still in the cecum. Excellent. We see, we're going to, it's going to come from 6 o'clock now. We're advancing, advancing. Push my scope, um, to get the grasper in the lumen. Now I'm going to. I'm gonna go in, push the grasper out. And I'm going to pull the balloon back. By pushing grasper out. OK, we're going to deflate the balloon a little bit. And you see the black line here, you see it? That's where the black line is. That helps you know where it's going to be the bending direction. And I'm pulling slowly. Just wait a little bit. Going to have to move this back. OK. Let me just get into position. Just till I get to the lesion. It's definitely hepatic flexure, yeah. All right, that's good. Too close. We'll pull back. All right, that's good. Now I pump the balloon up. I'm going in. We'll put some air. Put this back in, maybe pull it back if you can here. Nice, that's good. A pretty shortened colon. All right, that's good. OK, let me get a little close. Injection stuff. Yep. Yes. So now, we can do it this way. And now I'm gonna lock this. And if I want to move this way, we can do this or move even this. Yep. But I like it now. That is a nice direction. Inject. Stop. All right, we know now this is a vascular lesion. 3 times so far. I don't like too much coagulation. I like cut. So. Try and be careful. Inject Here again, see if it keeps moving, we have to pay attention. Because you don't want too much tension. A lot of vessels, I agree. And it's so funny, today, all the lesions are, they have fibrosis and submucosal fat, which creates this spark and then this, Haziness on the lens. Makes it so dirty. Inject. Stop. OK, I want to make sure the balloon doesn't fall back. OK, look at this. We opened it up. To the direction we want. Again, every once in a while I like to check and see, look at this nice structure in the way we want. And then we push a little bit. Make sure the balloon is not falling back. And now we're gonna go on the muscle. Inject. Stop. What are we doing? Uh, inject, Out. It's out. Inject? Injecting. Stop. Inject. Uh, Inject. Stop. Inject. Stop. It has bad fibrosis. No wonder. It's high grade dysplasia. They thought it's cancer, and that's all explained. That's still the caffeine, right? Um-hum. All black. All right. Is it out? Almost? Yeah. Oh, it's out. OK. It is. Yep, it's all. Completely out. Nice. Look at the black ink here. Really nice, decent size. All right, we'll start pinning now. All right, that's the final specimen. Probably around 4 centimeters, 4 by 3. Definitely high grade dysplasia. All right.
