Feasibility of endoscopic submucosal dissection of lesions at anastomosis site post-colorectal surgery: a case series

Abstract

Background and study aims Patients who have undergone colorectal surgery for resection of cancer and benign lesions are at risk for recurrent, residual, or metachronous lesions at the anastomosis site. Surgical resection of such lesions is difficult because of adhesions, and a stoma may be required as there are risks for leakage after resection. The feasibility and safety of endoscopic submucosal dissection (ESD) for these lesions remain unknown. Therefore, this case series aimed to examine the feasibility and safety of ESD by evaluating the clinical outcomes. Patients and methods We retrospectively investigated five patients who underwent ESD by a single expert for superficial neoplastic lesions at the anastomosis site after previous colorectal surgery. Results R0 resections were achieved for all lesions. Mean procedure time was 160.6 minutes. Mean dimensions of the resected specimen and tumor were 52.4 mm and 31.8mm, respectively. None of the patients had complications or recurrence after surveillance colonoscopy 1-year post-resection. Conclusions In an expert’s hands, ESD at the anastomosis site might be feasible minimally invasive treatment for superficial neoplastic lesions.

Endoscopic full‐thickness resection with endoscopic hand suturing for rectal neoplasm involved in an anastomotic line

“…In this case, full‐thickness resection was achieved without perforation toward the abdominal cavity. However, this procedure should be cautiously indicated to avoid perforation and a possible risk of cancer cell seeding 4,5 . Although we administered general anesthesia in the first experience of this procedure, we expect intravenous sedation in an endoscopic suite to be an option in the near future.…”

ESD using the pocket‐creation method enables complete resection of lesions at an anastomotic site

“…Patients who have undergone colorectal surgery for malignancies are still at risk of developing metachronous lesions in the residual colon including at the anastomotic site. For these lesions, ESD is technically more difficult than in a regular area due to the presence of severe fibrosis and staples from the previous surgery 5 . PCM is an innovative method to secure an endoscopic view even with severe fibrosis, enabling precise dissection of lesions.…”

Endoscopic submucosal dissection of a rectal lesion recurrence at the anastomotic site: when the staples lead the way

“…During the dissection, two adjacent 2mm microperfurations were noted, which were effectively closed with two over-the-scope clips. An R0 en bloc resection of a tubular adenoma with low and high grade dysplasia was achieved 1 2 .…”