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NAYANTARA COELHO-PRABHU: So advanced endoscopic procedures go beyond basic endoscopic mucosal resection of polyps.
LOUIS WONG KEE SONG: These techniques target lesions that are not amenable to simple resection. So these can be very large pre-cancerous lesions or flat lesions. They can be lesions that are [INAUDIBLE] down from prior attempts at resection.
NAYANTARA COELHO-PRABHU: These procedures include endoscopic submucosal dissection, which is where you take off a polyp or a lesion in one piece to facilitate better staging of the disease.
LOUIS WONG KEE SONG: This large lesion in the distal rectum is not suitable for conventional resection due to high likelihood of incomplete resection. The border of the lesion was marked with coagulation dots and the lesion removed en bloc using a specialized electrosurgical knife to dissect underneath the lesion, a technique known as endoscopic submucosal dissection, or ESD.
NAYANTARA COELHO-PRABHU: We are constantly inventing new therapeutic maneuvers. We've recently had a magnetic traction 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.
LOUIS WONG KEE SONG: 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 involve the appendiceal orifice or involve the ileocecal valve or are growing within a diverticulum or in the distal rectum. Patient assessment and lesion assessment is critical to determine the suitability as well as the type of endoscopic technique to be utilized.
NAYANTARA COELHO-PRABHU: Having a good set of images of the lesion, possibly a video clip, is very helpful.
LOUIS WONG KEE SONG: If there's a question of a potential for endoscopic resectability of a certain lesion, I would suggest a [INAUDIBLE] or even formal consult with a center that is proficient in advanced resection techniques, such as Mayo.
NAYANTARA COELHO-PRABHU: 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.
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