In this colon cancer prevention series, we would like to show you a flat lesion and its removal using endoscopic mucosal resection technique. A 70-year-old man with prior colon cancer resection and negative colonoscopies on several occasions came in for surveillance examination. As you can see here, there is a flat lesion evidenced by a red patch and cut-off of blood vessels and this was seen better after submucosal injection of saline followed dilute Indigocarmine injection at different points making the lesion more obvious. This is a 4 cm large flat II B lesion in the hepatic flexure and this was removed en-bloc using a stiff snare, 20 mm in size, and this was removed using coagulation current and endocut current. The edge of the lesion had a little bit of residual tissue that was removed with a biopsy forceps, and the edge was treated with argon plasma coagulation to prevent any delayed recurrence of the lesion. As you can see here, the argon plasma coagulation is being given to the edge of the lesion, and also a little bit to the base where there are small submucosal vessels to prevent any delayed bleeding. After successful resection, and cleaning up of the edges, the defect was closed with a series of clips from one end to the other end. And it is important to apply the clip starting with the lower edge and approximating the lower edge to the upper edge, and with little bit of gentle suction, you could grasp both edges. Make sure you grasp both edges, before you deploy the clip. This is the end result of a successful mucosal resection of a IIB flat lesion, followed by clip closure of the defect to prevent any delayed complications. The site was marked with sterile carbon particles (SPOT) and the specimen was retrieved and submitted for pathology. It is important to fix the specimen on a cardboard as shown here before submitting it to pathology. Here you see a tubular adenoma with high-grade dysplasia.
Gottumukkala S. Raju, MD, MD Anderson Cancer Center
Liben Mahometano, MD Anderson Cancer Center
Asif Rashid, MD, PhD, MD Anderson Cancer Center
Patrick Lynch, MD, MD Anderson Cancer Center