A balloon-assisted endoscopic submucosal dissection using long colonoscope and guidewire

Area of Science:

• Gastroenterology
• Endoscopic Surgery

Background:

• Proximal colorectal tumors present challenges for endoscopic submucosal dissection (ESD) due to poor scope maneuverability.
• Balloon-assisted endoscopy (BA-E) aims to improve scope stability and maneuverability during endoscopic procedures.

Observation:

• A patient with an ascending colon tumor experienced failed colonoscopy with standard BA-E due to excessive intestinal looping and poor maneuverability.
• Conventional therapeutic colonoscopy and BA-E techniques were insufficient to reach and treat the lesion.

Findings:

• A modified approach utilizing a long colonoscope inserted to the terminal ileum successfully reduced the colonic loop.
• Placement of a guidewire in the terminal ileum facilitated the subsequent insertion of a therapeutic colonoscope with an overtube.
• This technique allowed for safe and successful balloon-assisted endoscopic submucosal dissection (BA-ESD) of the ascending colon tumor without loop reformation.

Implications:

• This case demonstrates a viable alternative technique for performing BA-ESD in complex colonic anatomies where standard methods are unsuccessful.
• The described method offers a potential solution for improving treatment accessibility for proximal colorectal neoplasms.
• Further studies may explore the broader applicability of this modified long colonoscope and guidewire technique in challenging endoscopic cases.