In this video, Mayo Clinic gastroenterologists
Nayantara Coelho-Prabhu, M.B.B.S., and Louis M. Wong Kee Song, M.D., provide an overview of how new minimally invasive advanced endoscopic techniques are being used to treat lesions that previously required surgery. These procedures provide numerous benefits to the patient, including shorter recovery times and fewer potential complications. So, advanced endoscopic procedures go beyond basic endoscopic mucosal resection of polyps. These techniques target lesions that are not amenable to simple resection. So this can be very large pre cancerous lesions or flat lesions. There can be lesions that are scoured down from prior attempts at resection. These procedures include endoscopic sub mucosal dissection, which is where you take off a polyp or a lesion in one piece to facilitate better staging of the disease. This large lesion in the distal rectum is not suitable for conventional resection. Due to high likelihood of incomplete resection, the border of religion was marked with coagulation dots and religion removed on block using a specialized electra surgical knife to dissect underneath collision. A technique known as endoscopic mucosal dissection or E. S. D. We are constantly inventing new therapeutic maneuvers. We've recently had a magnetic attraction device approved to enable deeper resection techniques. Another exciting development has been the availability of endoscopic suturing devices and there are multiple of these now available. These allow you to suture the defect that you've created closed. This decreases the risk of post procedural complications such as bleeding or perforation and has made these procedures even safer. That is the beauty of these techniques is that they allow us to tackle challenging lesions whether it's size or whether it's location. So, for example lesions that involved the appendices, orifice or involving ideological valve or growing within a diverticular or in the distal rector patient assessment and lesion assessment is critical to determine the suitability as well as a type of endoscopic techniques to be utilized. Having a good set of images of the lesion, possibly a video clip is very helpful. If there's a question of a potential for endoscopic respectability of a certain lesion, I would suggest a curbside or even formal consult with a center that is proficient in advanced dissection techniques, such as mayo, having expertise and having the volume of cases that we see here with these difficult lesions allows us to be able to excel at this, and we would be able to tell both the patients as well as the referring providers. That oftentimes we can remove these lesions and save patients a significant amount of morbidity and indeed mortality.