The saline-immersion/irrigation technique for endoscopic submucosal dissection of a challenging colonic lesion using double-balloon endoscopy and a novel type of advanced imaging.

Background and Aims: Endoscopic submucosal dissection (ESD) offers effective en bloc resection of large colorectal lesions but can be technically challenging, especially for lesions with poor access. This video showcases successful use of the saline-immersion/irrigation technique (SITE), double-balloon endoscopy (DBE), and a novel type of advanced imaging for resection of such a lesion in a patient with a long sigmoid colon that compromised stability. Methods: A 64-year-old woman underwent ESD for an 80-mm Paris 0-Is lesion within the transverse colon. DBE was used to enhance access and stability. SITE with the pocket-creation method (PCM) and clip-band traction was used. In addition, a novel type of imaging, amber-red color imaging (Fujifilm Healthcare, Tokyo, Japan), designed to enhance visualization of the muscularis propria and any vessels, was also used. Results: The lesion was successfully resected en bloc. Hemostasis was achieved with knife-tip coagulation and intraprocedural application of protein-matrix gel, coupled with scope tamponade. Histopathology confirmed a tubulovillous adenoma with low-grade dysplasia, completely excised (R0). The patient recovered without adverse events and was discharged on the same day. Conclusions: DBE, combined with SITE, PCM, and a novel advanced imaging technology, facilitates ESD of challenging colorectal lesions.