ENDOSCOPIC MANAGEMENT OF COLONIC INTUSSUSCEPTION BY ESD- CASE SERIES

Aims:

Intussusception is telescoping of one bowel segment into another. Intussusception is rare in adults¹. Colonic involvement represents up to 50% of cases². Due to the high rates of malignancy and recurrence in adult intussusception, it has traditionally been considered an indication for surgery. We report our single center experience in management of adult colonic intussusception by Endoscopic Submucosal Dissection (ESD).

Methods:

Patients with colonic intussusception managed by ESD were identified from prospectively kept ESD database over an 7 year period (2010 – 2017). All patients underwent pre-ESD colonoscopy with reduction of intussusception by hydrostatic reduction method and relevant imaging (EUS/CT) to assess resectability and layer of origin. ESD was performed using standard colonoscope/gastroscope with distal transparent hood, Insulated Tip (IT) and Dual knives, CO₂ insufflation. Submucosal cushion was created using a modified gelatin solution stained with methylene blue injected through a sclerotherapy needle. General anaesthesia was used.

Results:

7 patients underwent endoscopic reduction of intussusception followed by ESD. Mean age 63.6 years, males-5. All patients presented with recurrent abdominal colic and abdominal distension over a period of 2 months. 3 (42.8%) of the lesions were in the ascending colon, 2 (33.3%) in sigmoid colon, 1 (16.7%) in transverse colon and 1 (16.7%) in rectum. Enbloc resection was achieved in 6 (85.7%) patients. Mean procedure time was 77.5 ± 30.6 minutes. Median lesion diameter was 3.75 cm. Intraprocedural bleeding was encountered in 1 (14.2%) patient requiring surgery. Mean hospital stay was 3.1 ± 1.4 days. Histopathology showed lipoma (100%) in all cases. Follow up colonoscopy at 8 weeks revealed complete mucosal healing.

Conclusions:

Endoscopic reduction of colo-colic intussusception followed by resection of lesions by ESD is safe and feasible in carefully selected patients.