Volume 2, Issue 12, Pages (December 2017)

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Volume 2, Issue 12, Pages 356-358 (December 2017) Endoscopic submucosal dissection by use of a modified dental floss clip method for recurrent tumor in the cecum Hisatomo Ikehara, MD, PhD, Tejas Kirtane, MD, Takuji Gotoda, MD, PhD, FASGE VideoGIE Volume 2, Issue 12, Pages 356-358 (December 2017) DOI: 10.1016/j.vgie.2017.09.001 Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 Laterally spreading tumor in the cecum. A, Conventional endoscopic image showing widespread tumor, approximately 4 cm in diameter. The yellow arrows indicate the edge of the lesion. B, C, Endoscopic piecemeal resection and argon plasma coagulation performed after endoscopic image was magnified by crystal violet staining. VideoGIE 2017 2, 356-358DOI: (10.1016/j.vgie.2017.09.001) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 Recurrent tumor on the endoscopic piecemeal mucosal resection scar 11 months later. A, Follow-up colonoscopic image showing shallow depressed lesion with a slightly reddish change. B, Dye-sprayed endoscopic image clearly shows margin of recurrent tumor. VideoGIE 2017 2, 356-358DOI: (10.1016/j.vgie.2017.09.001) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 Salvage endoscopic submucosal dissection for recurrent tumor. A, Mucosal incision around recurrent tumor. B, Dental floss clip attached to edge of mucosal flap, additional clipping applied on the opposite colon wall. Pulley-like effect obtained, and dental floss clip method used to unfold the mucosal flap. C, Direct confirmation of submucosal layer. D, Severely fibrotic area dissected without perforation. E, Complete resection achieved. VideoGIE 2017 2, 356-358DOI: (10.1016/j.vgie.2017.09.001) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 Pathologic view showing deep submucosal invasion with negative vertical margin (H&E, orig. mag. × 40). VideoGIE 2017 2, 356-358DOI: (10.1016/j.vgie.2017.09.001) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions