Endoscopy 2018; 50(08): 813-817
DOI: 10.1055/a-0602-3905
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Peranal endoscopic myectomy (PAEM) for rectal lesions with severe fibrosis and exhibiting the muscle-retracting sign

Takashi Toyonaga
1   Department of Endoscopy, Kobe University Hospital, Kobe, Japan
2   Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Yoshiko Ohara
1   Department of Endoscopy, Kobe University Hospital, Kobe, Japan
,
Shinichi Baba
2   Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Hiroshi Takihara
2   Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Manabu Nakamoto
3   Department of Gastroenterology, Heart Life Hospital, Okinawa, Japan
,
Hitoshi Orita
3   Department of Gastroenterology, Heart Life Hospital, Okinawa, Japan
,
Junji Okuda
4   Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan
› Institutsangaben
Weitere Informationen

Publikationsverlauf

submitted 05. November 2017

accepted after revision 05. März 2018

Publikationsdatum:
08. Juni 2018 (online)

Abstract

Background Although endoscopic submucosal dissection has enabled complete tumor resection and accurate pathological assessment in a manner that is less invasive than surgery, the complete resection of lesions with severe fibrosis in the submucosal layer and exhibiting the muscle-retracting sign is often difficult. We have devised a new method, peranal endoscopic myectomy (PAEM), for rectal lesions with severe fibrosis, in which dissection is performed between the inner circular and outer longitudinal muscles, and have examined the usefulness and safety of this new technique.

Methods All of the patients who underwent PAEM in our hospital and affiliated hospitals between July 2015 and June 2017 were retrospectively reviewed.

Results 10 rectal lesions were treated with PAEM. En bloc resection with a negative vertical margin was achieved in eight patients (80 %), whose lesions were mucosal (n = 2), shallow submucosal (n = 1), deep submucosal (n = 4), and muscle invasive (n = 1). The clinical course of all patients after PAEM was favorable. In patients who underwent additional surgery, anus preservation was achieved on the basis of the pathological results from PAEM.

Conclusions PAEM for lesions with severe fibrosis exhibiting the muscle-retracting sign appears to be both safe and useful.

 
  • References

  • 1 Tsujii Y, Nishida T, Nishiyama O. et al. Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study. Endoscopy 2015; 47: 775-783
  • 2 Lee TH, Cho JY, Chang YW. et al. Appropriate indications for endoscopic submucosal dissection of early gastric cancer according to tumor size and histologic type. Gastrointest Endosc 2010; 71: 920-926
  • 3 Repici A, Hassan C, De Paula Pessoa D. et al. Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia: a systematic review. Endoscopy 2012; 44: 137-150
  • 4 Jacob H, Toyonaga T, Ohara Y. et al. Endoscopic submucosal dissection of cecal lesions in proximity to the appendiceal orifice. Endoscopy 2016; 48: 829-836
  • 5 Ohara Y, Toyonaga T, Tsubouchi E. et al. Clinical course after endoscopic submucosal dissection in the rectum leaving a circumferential mucosal defect of 26 cm in length. Endoscopy 2016; 48 (Suppl. 01) E4-E5
  • 6 Toyonaga T, Tanaka S, Man-I M. et al. Clinical significance of the muscle-retracting sign during colorectal endoscopic submucosal dissection. Endosc Int Open 2015; 3: E246-E251
  • 7 Rahni DO, Toyonaga T, Ohara Y. et al. First reported case of per anal endoscopic myectomy (PAEM): A novel endoscopic technique for resection of lesions with severe fibrosis in the rectum. Endosc Int Open 2017; 5: E146-E150
  • 8 Tanaka S, Kashida H, Saito Y. et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection guidelines. Dig Endosc 2015; 27: 417-413
  • 9 Hayashi Y, Sunada K, Takahashi H. et al. Pocket-creation method of endoscopic submucosal dissection to achieve en bloc resection of giant colorectal subpedunculated neoplastic lesions. Endoscopy 2014; 46 (Suppl. 01) E421-E422
  • 10 Sumiyama K, Gostout CJ, Rajan E. et al. Submucosal endoscopy with mucosal flap safety valve. Gastrointest Endosc 2007; 65: 688-694
  • 11 Inoue H, Minami H, Kobayashi Y. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271
  • 12 Inoue H, Ikeda H, Hosoya T. et al. Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy 2012; 44: 225-230
  • 13 Yoshii S, Nojima M, Nosho K. et al. Factors associated with risk for colorectal cancer recurrence after endoscopic resection of T1 tumors. Clin Gastroenterol Hepatol 2014; 12: 292-302.e293
  • 14 Bignell MB, Ramwell A, Evans JR. et al. Complications of transanal endoscopic microsurgery (TEMS): a prospective audit. Colorectal Dis 2010; 12: e99-e103