Endoscopic Mucosal Resection of a Colon Adenoma Using ORISE™ Gel

Neil Sharma, M.D.
Parkview Cancer Institute
Parkview Health System
Fort Wayne, IN

Patient History

A 63-year-old patient was referred from outpatient GI services for endoscopic mucosal resection of a 2.5-centimeter adenoma found in the rectum on initial screening colonoscopy.

Procedure

After locating the adenoma (Paris classification 1-S), 2 cc’s of ORISE™ Gel was injected submucosally using a dynamic injection process. To achieve this, the needle, with fluid already being expelled prior to insertion, was passed forcefully into the adenoma and then slowly withdrawn until the lesion was lifted. Figure 1 shows adequate injection for this sessile 1-S Paris class adenoma.

FIGURE 1: Submucosal injection using ORISE™ Gel 1:40-3:05

The lesion was then resected with a Captivator™ II Single-use Snare. The snare was opened above the lesion and then slowly lowered, using the wheels, onto the lesion itself, to avoid mucosal trauma and to appropriately seat the lesion within the snare to capture the tissue. The snare was shaken as the entire lesion was resected, leaving no adenomatous tissue behind. (Figure 2) This allows for less cautery to be applied into the area.

FIGURE 2: Resection with Captivator II Single-use Snare 3:05-3:40

The clean margins were then ablated. The lesion was closed with the use of a single endoclip to reduce the risk of bleeding post resection. (Figure 3)

FIGURE 3: Ablation and closure 3:40-4:25

Outcome

Final examination of the post-ablation scar bed suggested a clean resection with an adequate char of haloed tissue around the mucosal resection bed. The specimen was retrieved en bloc, and oriented on a surgical board, per hospital pathology requirements. (Figure 4)

FIGURE 4: Specimen retrieval and processing 4:25-5:25

Conclusion

Dynamic injection of ORISE Gel is a valuable technique for the resection of colorectal adenoma. To learn more visit EndoSuite.com for a full presentation.

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