Endoscopic full-thickness resection of a nonlifting adenoma in an ileal pouch using an over-the-scope full-thickness resection device.

A 34-year-old man with familial adenomatous polyposis and ileo-anal pouch anastomosis was referred for treatment of a nonlifting Paris 0-IIb lesion. The lesion was located 3cm proximal to the ileo-anal anastomosis on the dorsal wall of the J-pouch. No malignant characteristics were seen on narrow-band imaging (Narrow-band imaging International Colorectal Endoscopic [NICE] classification type 2) (●" Fig.1). Full-thickness resection with an over-thescope full-thickness resection device (FTRD) was proposed (●" Video 1). After the lesion had been delineated using coagulation marks, the endoscope, together with the mounted FTRD, was inserted into the pouch. In the absence of mobile surrounding structures in this distally located lesion, it was considered safe to perform the full-thickness resectionwithout the use of the tissue grasper that was incorporated into the FTRD. Gentle suctioning was used to mobilize the lesion into the cap (●" Fig.2), after which the over-the-scope clip (OTSC) was deployed and immediate resection using the preloaded snare was performed. The resection was macroscopically complete. The muscular layer was grasped into the OTSC, thus preserving the integrity of the intestinal wall (●" Fig.3). The serosa was Fig.1 Nonlifting Paris 0-IIb lesion, located 3cm proximal to the ileo-anal anastomosis on the dorsal wall of the J-pouch. No malignant characteristics were seen on narrow-band imaging (Narrow-band imaging International Colorectal Endoscopic [NICE] classification type 2).