P2842 - Traction-Assisted Endoscopic Submucosal Dissection Using Novel Through-the-Scope Articulating Arm for the Resection of a Large Rectal Polyp

Glaser Dana, MD¹, Neal Dharmadhikari, MD¹, Ahmad Najdat Bazarbashi, MD^2
1Washington University School of Medicine in St. Louis, St. Louis, MO; ²Washington University School of Medicine in St. Louis / Barnes-Jewish Hospital, St. Louis, MO

Introduction: Endoscopic submucosal dissection (ESD) has emerged as an effective approach for en-bloc resection of large gastrointestinal lesions. Use of traction-assisted ESD has been shown to lead to shorter procedural times with similar safety and success rates, however, there is variation in traction-assisted devices available with many lacking rotational capabilities or dynamic traction. We present a case of a successful ESD of a large rectosigmoid polyp removed using a novel through-the-scope articulating arm.

Case Description/Methods: A 45 year-old female without significant past medical history presented for management of a large ( >50mm) sessile non-granular laterally spreading rectosigmoid polyp. ESD with the use of a through the scope articulating arm for traction was performed.

This innovative device is designed to enhance the applicability, safety and convenience of ESD by providing single-operator 360 degree traction assistance. It consists of three parts: a hand controller that attaches to the endoscope at the instrument port (figure 1A), a catheter that passes through a 3,7mm working channel of the endoscope (figure 1B), and an articulating and rotating alligator-jaw that allows for grasping, regrasping and traction (figure 1C).

Using a double channel endoscope, a sessile non-obstructing large 5cm x5cm mass (Paris Classification Is) was identified in rectum (Figure 1D). Thermal marking was done to identify borders. A circumferential mucosal incision was performed with a hybrid T-shaped ESD knife (figure 1E). The lesion was then dissected from the underlying deep layers with the electrocautery knife using traction-assisted articulating arm (figure 1F). The novel dynamic articulating arm was used to grasp the proximal end of the lesion and allowed for traction in various positions and directions, allowing better exposure of the submucosal layer and optimizing resection. A 60mm area was successfully resected. The patient was admitted for 23 hour observation. There were no complications. Pathology revealed tubulovillous adenoma with focal high grade dysplasia with clear margins.

Discussion: ESD is an effective method for removal of large gastrointestinal lesions, ensuring en-bloc resection and negative margins. Traction is a critical technique during ESD to enhance procedural success rates, and can be safely provided with this novel articulating traction device. Future case series and comparative studies are required to confirm its superiority to other traction devices and to other methods of ESD.



Disclosures:


Glaser Dana, MD¹, Neal Dharmadhikari, MD¹, Ahmad Najdat Bazarbashi, MD². P2842 - Traction-Assisted Endoscopic Submucosal Dissection Using Novel Through-the-Scope Articulating Arm for the Resection of a Large Rectal Polyp, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.