ENDOSCOPIA DIGESTIVA

A new case about the utility of incisional therapy for refractory esophageal stricture after surgical resection (epidermoid cervical esophageal cancer) after two balloon dilatations without any improvement result. Underwent EGD with a 9.8-mm-diameter endoscope (GIF-160 Olympus) in left lateral decubitus position under conscious sedation with propofol. A transparent hood was attached to the tip of the endoscope and an insulated-tip knife (IT-knife nano, Olympus) was introduced through the working channel. Under direct vision we apply radial incision of the stricture area (radial incision and cutting RIC) in combination with balloon dilatation (16 mm) and triamcinolone injection.

A 55-year-old male patient with alcoholic cirrhosis. Admitted at emergenci room for upper GI bleeding. Treatment with intravenous Somatostine was started and Erythromycin IV was indicated to empty the stomach. Esophageal varices and GOV1 without active bleeding were seen, initially. In the gastric esophagus union, a Mallory weis type lesion was observed and treated with a Hemoclip. Opposite the injury of Mallory Weiss, active bleeding occurs due to rupture of a GOV1. Initially we injected ethoxy-sclerol 1% in the variz without stopping the bleeding, We help with continuous washing with water and measure in cm to the dental arch to locate the lesion. Finally, due to the persistence of the bleeding, we placed two elastic bands.  

Impressive case where a DSE of a large lesion of postanal localization with non-homogenous LST-G morphology performed by Dr. Rosón. The technique used has been tunneling, where initially an incision is created in the anal margin of the lesion somewhat larger than 1 cm that allows access to the submucosal plane. Once the tunnel is made, an incision of similar size is made on the oral side of the lesion. Throughout this phase an endoknive Flushknife BT 1.5 mm has been used. The next phase is the lateral extension of the dissection where an IT-Nano was used. Finally, the lateral incisions were excised to resect all the lesion. In this area the vessels are redundant and thermocoagulated with coagrasper. As an injection solution as well as that used for the Flushknife it was a mixture of Voluven + indigo carmine + adrenaline.

Very interesting technique of hybrid ESD carried out with a single instrument (handle of Poilpectomy Snare Inflator of Medwork) by Dr. Rosón (Hospital Quirón, Málaga). This technique is very useful for flat lesions (like this 22 mm with LST-G morphology) located in areas of the colon with poor maneuverability such as the hepatic flexure.

Treatment with the RIC (radial incision and cutting) technique of low colorectal stenosis after rectal cancer surgery of the middle third (low anterior resection).  

Treatment with the RIC (radial incision and cutting) technique of stenosis of a high esophagogastric anastomosis (20 cm from the mouth) after surgery of a squamous cell carcinoma of the middle esophagus. The patient has undergone several dilations and placement of esophageal stent with early recurrence of dysphagia. With this last technique, it has improved a lot.

  At the beginning of the DSE technique, it is important to perform in small lesions and in locations where endoscopic maneuverability is very good. In this case a flushknife 1.5 mm BT has been used and the scar closed with hemoclips