Thin endoscope-assisted endoscopic submucosal dissection for large colorectal tumors (with videos)

BACKGROUND: Endoscopic submucosal dissection (ESD) enables direct submucosal dissection so even large early stage GI tumors can be resected en bloc. Colorectal ESD is technically more difficult, however, and there is an increased risk of complications such as perforation and bleeding compared with gastric ESD. As a result, further refinements are required in this procedure. OBJECTIVE: Our purpose was to evaluate thin endoscope-assisted (TEA) ESD, a new traction system for improving submucosal cutting line visualization. DESIGN: Case series. SETTING: Okayama University Hospital. MAIN OUTCOME MEASUREMENTS: Efficacy and safety of the TEA-ESD procedure. RESULTS: Three cases of large, flat, elevated colorectal tumors (laterally spreading tumors) in the rectum and rectosigmoid colon were safely and successfully removed en bloc without complications. Total procedure times were 3 hours, 40 minutes, and 30 minutes with resected specimens measuring 70 x 68 mm, 38 x 35 mm, and 30 x 20 mm, respectively. LIMITATIONS: TEA-ESD was performed in only the rectum and rectosigmoid colon. CONCLUSIONS: This limited case series demonstrated that large laterally spreading tumors in the rectum and rectosigmoid colon could be safely resected en bloc with TEA-ESD.     

Submucosal tunneling endoscopic resection for simultaneous esophageal and cardia submucosal tumors originating from the muscularis propria layer (with video)

Submucosal tunneling endoscopic resection (STER) is a new treatment technique for upper gastrointestinal submucosal tumors (SMT) originating from the muscularis propria (MP) layer. In contrast to conventional endoscopic resection, the new therapy can maintain the mucosal integrity of the digestive tract, which effectively prevents mediastinitis and peritonitis. STER, although a known method, has not been widely adopted because of technical difficulties. Here, we describe the case of a 30‐year‐old patient presenting with two separate SMT originating from the esophageal and cardia MP layer. A 2‐cm longitudinal mucosal incision was made approximately 5 cm proximal to the esophageal SMT, and the esophageal and cardia SMT were dissected successively in the same submucosal tunnel. In the relevant literature, this is the first case of STER for resecting esophageal and cardia SMT using the same submucosal tunnel.