Friends of Endoscopy
  • Home
  • Quiz Cases
  • Endoscopy Long Cases
  • Short Teaching Clips
  • Blackboard teaching
  • Podcasts
  • Core Reading
    • Basic concepts core reading
    • Gastroscopy core reading
    • Colonoscopy core reading
    • QA core reading
  • About
    • Our sponsors
  • Home
  • Quiz Cases
  • Endoscopy Long Cases
  • Short Teaching Clips
  • Blackboard teaching
  • Podcasts
  • Core Reading
    • Basic concepts core reading
    • Gastroscopy core reading
    • Colonoscopy core reading
    • QA core reading
  • About
    • Our sponsors
Search
Picture
​

Friends of Endoscopy is all about pattern recognition.  See it today and recognise it tomorrow!   Learn from a New Case on most weekdays !!! 
Become a Better Endoscopist ! 

Abort or Attack?

10/12/2020

 
I was asked to remove this sigmoid lesion. Previous samples have revealed a TA+HGD.  The dark colouration is due to a previous ink tattoo, placed rather too close to the lesion itself for my liking. 
SHOULD I ABORT OR ATTACK?
ABORT!
Correct!
ATTACK!
WRONG!
EXPLANATION
When this question was first published on our FB group, >95% correctly answered;  Abort ! 

The complete absence of a crypt pattern means that this lesion should not be endoscopically resectable. The Japanese would say that there is evidence of 'massive invasion' (invasion beyond 2mm below the muscularis mucosa).   Of course, I confirmed my impression with a 'test-lift', which of course failed.

Subsequently, surgery confirmed that the lesion was T3 (invading through the muscle propria layer) but luckily no nodes were involved.  

The take-home message?  If a 'test lift' had been done a the first examination, we could have saved a lot of time.  A test-lift will not scupper a future endoscopic resection! 

    Categories

    All
    Barrett's
    Cancer
    Cancer Syndromes
    Colitis
    Colorectum
    Corrosive Ingestion
    Crypt Pattern
    Difficulty: Hard
    Difficulty: Moderate
    Difficulty: Very Hard
    Duodenum
    Eosinophilic Oesophagitis
    EUS
    Foveolar Metaplasia
    Gastric
    Gastroscopy
    GI Bleeding
    Histology
    HPB
    Ileum
    Immunosuppression
    Infection
    Local Recurrence Of Barrett's Ca.
    Lymphoma
    Mixed Polyp
    Mucosal Prolapse Syndrome
    NET
    Non-lifting Sign
    Oesophagus
    Opinion Piece!
    Pharynx
    Polyp
    Polypectomy
    The Basics
    TSA

  • Home
  • Quiz Cases
  • Endoscopy Long Cases
  • Short Teaching Clips
  • Blackboard teaching
  • Podcasts
  • Core Reading
    • Basic concepts core reading
    • Gastroscopy core reading
    • Colonoscopy core reading
    • QA core reading
  • About
    • Our sponsors