|Tillinger W, Reckendorfer H|
Der Endorotor® – Ein neues endoskopisches Resektionssystem: Fallbericht // The EndoRotor® – a novel endoscopic device for mucosal resection. A case report
Journal für Gastroenterologische und Hepatologische Erkrankungen 2017; 15 (1): 10-13
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Keywords: EMR, endoskopische Mukosaresektion, Kolonpolypen, Koloskopie, colonic polyp, colonoscopy, endoscopic mucosal resection
Endoscopic removal of colonic polyps is associated with reduced mortality from colorectal cancer. Large non-pedunculated polyps are safely removed with snares by means of endoscopic mucosal resection (EMR). However, reoccurrence of polyps after EMR may occur in up to 20% of patients and further removal may be hampered due to the formation of scar tissue.
Furthermore, the histologic examination may be difficult due to thermic alteration of the tissue samples by electrocautery. Here we present a novel device for EMR. The EndoRotor® is a non-thermal, automated mechanical endoscopic resection system, designed to remove benign mucosal neoplastic tissue throughout the gastrointestinal tract. It uses suction pressure to pull mucosa into a catheter, cut it by a blade rotating inside that catheter while automatically transporting the samples into a collection trap for histologic evaluation. The mucosal layer is selectively sucked into the catheter due to the different viscoelastic properties of the mucosal and the muscularis layer.
Case report: We present the case of a 90 year old male patient with a rectal adenoma, which was not amenable to a snare removal due to the formation of extensive scar tissue after repeated previous attempts of EMR. A surgical resection was not considered as an alternative due to serious comorbidities. The lesion extended in a length of 3 cm over the whole circumference. The proximal part was located on a scarred stenosis, yet passable with the endoscope. By using the EndoRotor® the whole lesion could be removed in two sessions. Minor bleeding was controlled by means of adrenalin-injection and coagulation with argonplasma. No further complications occurred.
Discussion: The EndoRotor® is a novel device for EMR. In the present case the EndoRotor® proved to be effective and safe. In particular for scarred polyps non amenable to snare resection the device may be a valuable tool. Further studies addressing efficacy and safety will determine its role in interventional endoscopy.
Kurzfassung: Die endoskopische Abtragung von
Kolonpolypen reduziert die Mortalität bei kolorektalen
Karzinomen. Auch große, nicht-gestielte
Polypen können mittels Schlinge durch endoskopische
Mukosaresektion (EMR) sicher abgetragen
werden. Rezidivpolypen nach EMR sind
allerdings in bis zu 20 % der Patienten zu beobachten
und weitere Abtragungen können durch
Narbengewebe im Abtragungsbereich erheblich
erschwert werden. Darüberhinaus beeinträchtigen
thermische Alterationen durch Kautereffekte
die histologische Beurteilbarkeit des entnommenen