Endoscopic intermuscular dissection for deep submucosal invasive cancer in the rectum: a new endoscopic approach

Abstract

Risk for lymph node metastasis associated with deep submucosal invasion should be balanced against mortality and morbidity of total mesorectal excision (TME). Dissection through the submucosa (ESD), hinders radical deep resection margins, and full thickness resection (TEM/TAMIS) may influence the outcome of completion TME. Endoscopic intermuscular dissection (EID) in between the circular and longitudinal part of the muscularis propria could potentially provide an R0 resection while leaving the rectal wall intact. In this prospective cohort study, data of patients treated with EID for suspect deep submucosal invasive rectal cancer between 2018-2020 were analysed. Study outcomes were the percentages of technical success, R0 resections, curative resections, and adverse events. In total 67 cases (age 67 yrs; 73% male) were included. Median lesion size was 25 mm (IQR 20-33). Overall technical success, R0 resection, and curative resection rates were (96%; 95%CI 90-100%), 81% (95%CI 72-90%) and 45% (95%CI 33-57%). Only minor adverse events occurred in 8 patients (12%). EID for deep invasive T1 rectal cancer appears to be feasible and safe, and the high R0 resection rate creates a rectal preserving potential in 45% of patients.

Endoscopic intermuscular dissection with intermuscular tunneling for local resection of rectal cancer with deep submucosal invasion

“…11 More recently, this resection technique has also been used to resect rectal cancers with suspected >Sm1 invasion. 12 The results from this prospective series of 67 patients suggest that EID is safe (no surgery for EID-related adverse events, 12% minor adverse events) and feasible (technical success rate 96%). Here, we present a step-by-step video explanation of the EID technique, which was used to resect a rectal lesion with a small focus of suspected deep submucosal invasion (Video 1, available online at www.giejournal.org).…”

Diagnostic endoscopic submucosal dissection for colorectal lesions with suspected deep invasion

“…Full-thickness resection with the full-thickness resection device (FTRD) system is an alternative to obtain a deeper resection when the overall size of the lesion is < 20 mm 17 ; however, a size < 20 mm is rare for these relatively advanced lesions. A newer option, endoscopic intermuscular resection, allows the whole thickness of the submucosa to be reached, but data are needed to demonstrate its efficacy and safety 18 .…”

“…Unauthorized distribution is strictly prohibited. option, the endoscopic intermuscular resection, allows to reach the whole thickness of the submucosa, but data are needed to demonstrate its efficacy and safety [18].…”

Endoscopic intermuscular dissection for a lower rectal gastrointestinal stromal tumor

“…2 ). We considered selective resection to preserve the external longitudinal muscle and subsequently performed endoscopic intermuscular dissection 4 . We used a GIF-H290 T gastroscope (Olympus, Tokyo, Japan) with an ST hood short-type tip (DH-28GR; Fujifilm, Tokyo, Japan) and resected the tumor using a DualKnife J (Olympus, Tokyo, Japan) and injection of hyaluronic acid.…”