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Endoscopy
Endoscopy
10.1055/s-00000012
Endoscopy
Endoscopy
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10.1055/a-2381-4993
E-Videos-2024-06-5095-EV
E-Videos
Endoscopic submucosal dissection combined with endoscopic hand-suturing for a superficial esophageal cancer in a diverticulum
Song Shibo Dr.
Zhang Chen Dr.
Wang Guiqi Dr.
Dou Lizhou MM
1 Endoscopy Center, Peking University First Hospital, Beijing, China
2 26447 Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Correspondence Lizhou Dou, MM Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College17 Panjiayuan NanliChaoyang District, Beijing 100021Chinaddx198707@163.com
06 9 2024
12 2024
1 9 2024
56 Suppl 1 E772E773
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
2024
The Author(s).
https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
CAMS Innovation Fund for Medical Sciences (CIFMS)2021-I2M-1-010, 2021-I2M-1-013, 2021-I2M-1-015, 2021-I2M-1-061, 2022-I2M-C&T-B-054 Capital’s Funds for Health Improvement and ResearchCRF2020-2-4025 Sanming Project of Medicine in ShenzhenSZSM201911008 Beijing Hope Run Special Fund of Cancer Foundation of ChinaLC2022B05, LC2021A03
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pmc Superficial esophageal cancer (SEC) occurring in a diverticulum is extremely rare 1 2 . Endoscopic submucosal dissection (ESD) is the preferred treatment for SEC, but diverticulum increases the risk of perforation, necessitating preventive measures. For the first time, we present a case in which an SEC in a diverticulum was safely and successfully cured using ESD combined with endoscopic hand-suturing (EHS).

A 65-year-old man was diagnosed with an SEC (28–31 cm from the incisors) during follow-up after radical gastrectomy ( Fig. 1 ). Despite the biopsy showing high grade intraepithelial neoplasia (HGIN), the patient underwent ESD due to its malignant potential.

Fig. 1 A superficial esophageal cancer (yellow arrows) on the surface of a diverticulum.

Labeling, submucosal injection, and submucosal dissection were performed according to ESD protocols. The lesion was removed en bloc without perforation ( Video 1 ). A depression of the muscularis propria was observed in the defect ( Fig. 2 ). To prevent delayed perforation, we sutured the depression using EHS ( Fig. 3 , Video 1 ). The prototype needle holder (entrusted manufacturer: Vedkang, Jiangsu, China) used for EHS was designed by our team ( Fig. 4 ). Notably, to achieve successful suturing, we made some modifications to the V-loc 180 needle with absorbable barbed suture (VLOCL0803; Covidien, Mansfield, Massachusetts, USA), including appropriately straightening the curvature of the needle and shortening the suture thread ( Fig. 5 ).

A superficial esophageal cancer on the surface of a diverticulum was completely removed via endoscopic submucosal dissection, and the depression of the muscularis propria in the defect was closed via endoscopic hand-suturing.

Video 1

Fig. 2 A depression of the muscularis propria (yellow circle) in the defect after endoscopic submucosal dissection.

Fig. 3 The closed depression in the defect.

Fig. 4 The prototype needle holder (entrusted manufacturer: Vedkang, Jiangsu, China) designed by our team.

Fig. 5 The modified V-loc 180 needle. The curvature of the needle was appropriately straightened and the suture thread was properly shortened.

The resection time and suture time were 31 minutes and 20 minutes, respectively. The patient was allowed to have a liquid diet on postoperative day 4 and was discharged on postoperative day 5 without adverse events. Histology confirmed complete resection of HGIN. The gastroscopy after 3 months showed good healing of the defect.

The use of ESD combined with EHS for treating SEC in a diverticulum has not been reported previously. In this case, the lesion was completely removed via ESD, and postoperative adverse events were effectively avoided via EHS. Further accumulation of clinical experience is desirable.

Endoscopy_UCTN_Code_TTT_1AO_2AG_3AD

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E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos .

Conflict of Interest The authors declare that they have no conflict of interest.
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References

1 Tanaka K Yabuuchi Y Yamashita D Endoscopic submucosal dissection for a superficial esophageal squamous cell carcinoma located in a Rokitansky diverticulum Endoscopy 2022 54 E986 e987 35926537
2 Hamada Y Ikenoyama Y Umeda Y Endoscopic submucosal dissection for superficial esophageal cancer in a diverticulum: a case report with literature review JGH Open 2024 8 e13026 38268960
