ENDOSCOPIA DIGESTIVA

Interesante dispositivo de Lumendi, el Dilumen-C, evolución del Dilumen-EIP, que incorpora dos canales de trabajo permitiendo el uso de instrumentos de tracción (los denominados Ig -interventional grasper- e IgE -interventional grasper elbow-). En los videos que se pueden consultar online en la revista, se entiende muy bien el funcionamiento de los sistemas de tracción. Este dispositivo se acerca mucho al concepto de la cirugía laparoscópica, dando a la tracción un papel muy importante en las técnicas endoscópicas de resección mucosa del colon. Pongo acceso a la publicación y el material suplementario para su consulta Link de acceso

The Dilumen platform is very useful in ESD where access to the lesion is very difficult (for example in patients with loops (generally in sigma -alpha loop-), in lesions located behind folds and in those where there is fibrosis. It incorporates a movable distal balloon and a proximal balloon located in the device’s overtube, as well as an accessory channel through which a rotary clamp can be inserted in the three dimensions of the space to make traction from the created mucosa flap.

Among the greatest difficulties in learning ESD in our environment, at least for me, is the approach to lesions in the right colon or those locations distal to the sigmoid colon when one or more loops are formed (generally in sigmoid and / or or transverse colon). Faced with this situation we can find ourselves with several problems. One of them may be that the lesion cannot be accessed with a short colonoscope or even though it is reached with a long colonoscope, the maneuverability and stability can make the technique very difficult. In fact, in my experience, this is the main reason for conversion to mucosectomy. Among the different options that exist to treat these lesions using ESD is the use of double balloon colonoscopes (Fujifilm model EI-580 BT). This endoscope, based on the double balloon enteroscopy technique, has a 3.2 mm channel and the working length of a standard long colonoscope (1550 mm). It allows the reduction of loops and to be able to maneuver properly in the ESD. The only drawback that I see is that it does not have a waterjet channel. This can be stressful if significant bleeding occurs. As seen in the video, Professor…

An ex-vivo pig stomach model (version 2.0) is presented for endoscopic submucosal dissection elaborated by Dr. Julio Guilarte.

Se expone el caso de una lesión en recto alto con morfología granular mixta (LST-GM) de 40-45 mm en una paciente de 72 años con colitis ulcerosa izquierda inactiva. Se realiza una DSE clásica con sistema de multitracción (MTL) basado en un EZ-Clip premontado con 2-3 aros de nylon de 15 mm. Els sistema se auxilia con tracción con «rubber band» de 1/4″ (6.35 mm) en el margen lateral derecho.

Excellent masterclass of an ESD in the sigmoid colon with LST-GM morphology, 80 mm by Prof. Katsumi Yamamoto

A new «more western» concept of ESD with the CROMA platform and the Speedboat RS-2 device («in vivo» animal model). The use of «bipolar radiofrequency» for incision and dissection and «microwave cogaulation», the 1: 1 rotation and the isolated base of the RS-2 make everything easier.

Performance of FTRD (full thickness resection device) in a patient with residual adenoma with previous EMR attempts by Doctors Rosón y Gallardo during the course «Third space and mucosal resection in digestive endoscopy» on May 6th and 7th, 2021 in the digestive unit of the Poniente hospital ( El Ejido. Almería)