Year 2018 / Volume 110 / Number 12
Case Report
Endoscopic submucosal hydro-dissection as a rescue treatment of a large recurrent lateral spreading tumor in an ileorectal anastomosis

829-831

DOI: 10.17235/reed.2018.5690/2018

Joaquín Rodríguez Sánchez, Mónica Sánchez Alonso, José Olmedo Camacho,

Abstract
Background: subtotal colectomy with ileorectal anastomosis (IRA) is currently the most common surgical option in young patients with familial adenomatous polyposis (FAP). However, this surgery does prevent the appearance of lesions in the rectal remnant. In these cases, the endoscopic submucosal dissection might be a feasible option. However, drawbacks such as extreme fibrosis and a difficult maneuverability in the rectal remnant make this technique rather challenging. An ESD by the pocket creation method was planned with the purpose of overcoming these handicaps. Case report: an en-bloq resection of 30 mm of the recurrent adenoma located in rectal remnant of a 42-year-old woman with FAP was successfully achieved following this approach. Two months of follow up endoscopy did not show residual adenomatous tissue. Discussion: in summary, endoscopic submucosal dissection by the pocket creation method allowed a safe and effective dissection and an en-bloc resection of this challenging polyp was achieved.
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References
1. Koskenvuo L, Renkonen-Sinisalo L, Jarvinen HJ, et al. Risk of cancer and secondary proctectomy after colectomy and ileorectal anastomosis in familial adenomatous polyposis. Int J Colorectal Dis 2014;29:225-30.
2. Belderbos TD, Leenders M, Moons LM, et al. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014;46:388-402.
3. Sansone S, Nakajima T, Saito Y. Endoscopic submucosal dissection of a large neoplastic lesion at the ileorectal anastomosis in a familial adenomatous polyposis patient. Dig Endosc 2017;29:390-391.
4. Rodriguez Sanchez J, de la Santa Belda E, Gonzalez Lopez L, et al. Endoscopic transmural hydro-dissection as a rescue therapy for rectal fibrotic adenoma. Endoscopy 2018. doi: 10.1055/s-0044-101598
5. Sakamoto H, Hayashi Y, Miura Y, et al. Pocket-creation method facilitates endoscopic submucosal dissection of colorectal laterally spreading tumors, non-granular type. Endosc Int Open 2017;5:E123-E129.
1. Koskenvuo L, Renkonen-Sinisalo L, Jarvinen HJ, et al. Risk of cancer and secondary proctectomy after colectomy and ileorectal anastomosis in familial adenomatous polyposis. Int J Colorectal Dis 2014;29:225-30.
2. Albeniz E, Pellise M, Gimeno-Garcia AZ, et al. Clinical guidelines for endoscopic mucosal resection of non-pedunculated colorectal lesions. Rev Esp Enferm Dig 2018;110:179-194. doi: 10.1016/j.gastrohep.2017.08.013
3. Sansone S, Nakajima T, Saito Y. Endoscopic submucosal dissection of a large neoplastic lesion at the ileorectal anastomosis in a familial adenomatous polyposis patient. Dig Endosc 2017;29:390-391.
4. Rodriguez Sanchez J, de la Santa Belda E, Gonzalez Lopez L, et al. Endoscopic transmural hydro-dissection as a rescue therapy for rectal fibrotic adenoma. Endoscopy. 2018 Jun;50(6):E121-E123. doi: 10.1055/s-0044-101598
5. Sakamoto H, Hayashi Y, Miura Y, et al. Pocket-creation method facilitates endoscopic submucosal dissection of colorectal laterally spreading tumors, non-granular type. Endosc Int Open 2017;5:E123-E129.
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Rodríguez Sánchez J, Sánchez Alonso M, Olmedo Camacho J. Endoscopic submucosal hydro-dissection as a rescue treatment of a large recurrent lateral spreading tumor in an ileorectal anastomosis. 5690/2018


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Publication history

Received: 01/05/2018

Accepted: 13/07/2018

Online First: 22/10/2018

Published: 03/12/2018

Article revision time: 69 days

Article Online First time: 174 days

Article editing time: 216 days


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