In nonlifting cases, because of underlying fibrosis endoscopic submucosal dissection may be necessary for complete resection.14 Figure options Download full-size image Download high-quality image (240 K) Download as PowerPoint slide Fig. 48. Ensuring complete resection. Close endoscopic visualization of the surroundings of the resection area to ensure complete resection cannot be overemphasized. In this case, indigo carmine is applied EPZ5676 to delineate its borders. EMR is performed, showing significant fibrosis. However, close inspection of the defect borders shows residual lesion

(arrows). Repeat snare of the site is immediately performed to achieve complete resection. Argon plasma coagulation is then used to coagulate the base and edges of the resection. Figure options Download full-size image Download high-quality image (284 K) Download as PowerPoint slide Fig. 49. Evaluation of the surroundings is critical. Following resection, close inspection of the resection defect borders should be performed, and any residual neoplasia removed. In addition, the mucosa

around the site should be biopsied to exclude the presence of invisible dysplasia. Figure options Download full-size image Download high-quality image (315 K) Download as PowerPoint slide Fig. 50. Multiple nonpolypoid neoplasms can be endoscopically resected during a single procedure. A 62-year-old patient with long-standing Crohn’s colitis underwent surveillance colonoscopy Vincristine mw that showed multiple neoplasms distributed throughout the colon. (1A to 1C) and (2A to 2E) illustrate details of diagnosis Progesterone and resection of the lesions. Chromoendoscopy using indigo carmine 0.4% was used for delineation of the borders and examination of the epithelial surface. En bloc EMR resections were performed (1C, 2E). Histopathology showed LGD within chronic colitis. Figure options Download full-size image Download

high-quality image (543 K) Download as PowerPoint slide Fig. 51. Endoscopic resection in patients with Crohn or ulcerative colitis can be very difficult because of underlying thickened mucosa and fibrosis. Multiple biopsies for removal of such lesions must be avoided. EMR is usually the most appropriate endoscopic therapy, noting still the high level of difficulty and risk in endoscopic resection of IBD lesions. Endoscopic submucosal dissection may be necessary for complete resection in some cases, such as shown here. Following injection of the submucosa, there is minimal lifting. Thus, a dual knife is used to make a circumferential incision around the lesion border and dissect the fibrosis submucosally, after which a snare is used to remove the lesion in one piece. Figure options Download full-size image Download high-quality image (195 K) Download as PowerPoint slide Fig. 52. Severe fibrosis in Crohn’s or ulcerative colitis can make endoscopic removal technically difficult.