Endoscopic submucosal tunnel dissection for a giant adenoma of the cecum (case report)

Endoscopic removal of giant adenomas of the cecum is associated with high risk of perforation and conversion to laparoscopic procedure. Endoscopic submucosal dissection for cecal adenomas had technical limitations due to the adjacent ileocecal valve and appendix opening, perpendicular operating angle. Case presentation of the possibility of successful removal of a large laterally spreading cecal adenoma by the method of endoscopic submucosal tunnel dissection (ESTD) never been described before for this tumor site and size. Patient 54 years old, an LST-G adenoma (5 cm in diameter, according to Kudo – IIIL, according to Sano – II) was detected in the dome of the cecum during colonoscopy. ESTD. The postoperative period without any unfavorable events; the patient was discharged on the 5th day after surgery. The morphological conclusion: tubulo-villous adenoma with moderate epithelial dysplasia, R0. ESTD is suitable for cecal giant adenomas.

First successful experience of the Zenker's diverticulum endoscopic therapy in Kazakhstan

Zenker's diverticulum tends to occur in the elderly and is generally a relatively rare disorder; the prevalence of Zenker's diverticulum is 1.5–5% of all esophageal diverticula. Men are affected 2-3 times more frequently than women. To date, Zenker's diverticulum is treated mostly by surgery in Kazakhstan, however, with the development of endoscopy the minimally invasive method, endoscopic diverticuloesophagostomy, is being implemented. The transoral treatment is aimed at creating the common cavity between the esophagus and the diverticulum in order to prevent food accumulation in the diverticulum. The anterior wall between these two structures consists of the diverticular wall, m. сricopharyngeus and esophagus wall, the septum transsection automatically ensures myotomy. Both open surgery and endoscopic transoral treatment of Zenker's diverticulum result in reduced symptoms in 94–100% of patients. The paper reports the first successful experience of the Zenker's diverticulum treatment by endoscopic submucosal tunnel dissection in Kazakhstan.