There are 3 Barrett nodules in the lower
esophagus. The largest one is about 5 mm. Flushing of the esophageal mucosa
with acetic acid followed by methylene blue was done. After that, washing of
the methylene blue with saline was applied. Injection of dye (saline 2ml,
methylene blue 2ml, and diluted adrenaline) under the largest Barrett nodule
was done. The suction of the nodule using rubber band ligator was done. After
that, the cap of the rubber band was applied on the tip of the endoscope, and
the scope was introduced into the esophagus. The oval snare was used in the
cutting of the nodule. We examine the area of the submucosa after excision of
the nodule.
Some notes during the procedure:
1- When injecting the dye in the submucosa, it was difficult to inject in
the caudad side( stomach side) of the lesion, so we do the injection in the
cephalad side( oral side). Unfortunately, after doing the injection, the
cushion disappears rapidly. Also, the cushion makes the lesion challenging to
access (the lesion was bent down towards the stomach).
2--After banding the lesion, I try to insert the snare into the scope with
the band apparatus, but the snare cannot pass, as the snare is not a modified
one and the band apparatus is the one used for esophageal varices( not a
specialized one).
3-We use the plastic portion of the band device instead of the specialized
cap.
4-After excision of the lesion( above the band),
you can notice a part of mucosa still attached to the band, this is because the
snare is not thoroughly co-opted with the band cap and the large size of the snare.
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