VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy · 2025
The continuous low-pressure saline perfusion method of endoscopic submucosal dissection for the circumferential tumor in the remnant rectum after the Hartmann's procedure.
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Hashimoto Kosei, Yamashita Tatsuya, Ogawa Kazunori, Kurata Hidekazu, Sakamoto Hirotsugu, Despott Edward J, Hayashi Yoshikazu, Yamamoto Hironori
Аннотация
BACKGROUND AND AIMS: Continuous low-pressure saline perfusion in endoscopic submucosal dissection (ESD) combines drainage tubes with saline-immersion therapeutic endoscopy, eliminating bubbles from high-frequency devices, enhancing visualization, and maintaining a deflated lumen. We applied this technique to safely resect a large circumferential lesion in the remnant rectum after the Hartmann's procedure where the mucosa was very fragile.
METHOD: An 82-year-old man with a 90-mm circumferential laterally spreading tumor in the Hartmann's remnant rectum underwent ESD. A nasogastric drainage tube was inserted in an alpha shape, and continuous low-pressure saline perfusion in ESD was performed. The "Asclepius tube" technique also was used to maintain stable drainage and lumen deflation.
RESULTS: The procedure was completed safely within 140 minutes, with excellent visibility and no adverse events noted. Pathology showed an intramucosal, well-differentiated adenocarcinoma with negative margins. A total of 4000 mL of saline was infused, 85% of which was recovered through the drainage tube.
CONCLUSIONS: Continuous low-pressure saline perfusion in ESD is a safe and effective technique for large lesions in the Hartmann's remnant rectum, providing stable lumen collapse, enhanced visibility, and minimal mucosal trauma.
METHOD: An 82-year-old man with a 90-mm circumferential laterally spreading tumor in the Hartmann's remnant rectum underwent ESD. A nasogastric drainage tube was inserted in an alpha shape, and continuous low-pressure saline perfusion in ESD was performed. The "Asclepius tube" technique also was used to maintain stable drainage and lumen deflation.
RESULTS: The procedure was completed safely within 140 minutes, with excellent visibility and no adverse events noted. Pathology showed an intramucosal, well-differentiated adenocarcinoma with negative margins. A total of 4000 mL of saline was infused, 85% of which was recovered through the drainage tube.
CONCLUSIONS: Continuous low-pressure saline perfusion in ESD is a safe and effective technique for large lesions in the Hartmann's remnant rectum, providing stable lumen collapse, enhanced visibility, and minimal mucosal trauma.