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Use of endoscopic sleeve to achieve full-thickness endoscopic resection of malignant polyp under direct vision.

Therapeutic decisions for early-stage colon cancer discovered after polypectomy are complex [1]. Surgical colectomy is associated with a low rate of residual cancer, but significant morbidity. In select patients, endoscopic full-thickness resection (EFTR) may be an option [2, 3]. We report EFTR using an endoscopic sleeve (Dilumen; Lumendi) with multiple endoscopic tools. The endoscopic sleeve has two balloons to improve the navigation and stability of the colon. The fore-balloon is extended using pushrods to create the “therapeutic zone” [4]. However, the fore-balloon cannot be deployed in the cecum or near an anastomosis (▶Fig. 1). In the present case, the fore-balloon and pushrods were removed in order to use two additional instruments via the empty pushrod channels. Moreover, one additional tool E-Videos