S4171 Minimally Invasive Management of Cecal Mass in High-Risk Surgical Candidate

Introduction: Previously available endoscopic ultrasound (EUS) techniques included radial and linear varieties. Radial EUS was used for diagnostic purposes while Linear EUS was used for therapeutic purposes. However, they had a limitation in accessing structures located far beyond duodenum in upper gastrointestinal tract and sigmoid colon in lower gastrointestinal tract. Case Description/Methods: A 40-year-old man with past medical history of liver cirrhosis secondary to alcohol use disorder, thrombocytopenia, portal hypertension presented with acute blood loss anemia secondary to hematemesis and melena. The patient underwent esophagogastroduodenoscopy and colonoscopy, significant for erosive antral gastritis and cecal mass, respectively. The following scores were calculated in the patient to compute the risk associated with his clinical condition and anticipatory surgery. Mayo Clinic post-operative mortality risk in patient with cirrhosis: 23.18% in 90 days (about 3 months). Child Pugh Score for cirrhosis mortality: Class C with abdominal surgery perioperative mortality risk 82%. Model for End-Stage Liver Disease-Sodium: 27 points with estimated 3-month mortality risk 19.6%. A radial endoscopic ultrasound (EUS; Fujifilm Endoscopy) was used to evaluate the cecal mass to confirm the pedunculated component with blood flow through the stem and mucosal origin without any infiltration into the muscularis propria. Due to significant risk secondary to multiple comorbidities, decision was made to proceed with standard colonoscopy and polypectomy was performed with closure of defect with through-the-scope clips (TTSC). Polyp was identified to have a mucosal pattern consistent with Narrow band imaging (NBI) International Colorectal Endoscopic Classification (NICE) category 2. Discussion: Use of the new radial EUS scope (Fujifilm Endoscopy) was significantly important in improving patient outcomes in this case as it allowed for mass evaluation beyond sigmoid colon which was a limitation in the previous versions. This is primarily because this newer version has a front viewing camera which allows for deeper insertion which was previously not easily possible. This allowed for polypectomy on standard colonoscopy instead of surgical resection hence reducing risk of operative complications. Watch the video: https://tinyurl.com/25ACGS4171