Endoscopy 2021; 53(02): E46-E47
DOI: 10.1055/a-1174-6018
E-Videos

Transanal minimally invasive surgery after incomplete resection of a rectal polyp using a full-thickness resection device

Javier Valdés-Hernández
1   Colorectal Surgery Unit, Virgen Macarena University Hospital, Seville, Spain
,
Auxiliadora Cano
1   Colorectal Surgery Unit, Virgen Macarena University Hospital, Seville, Spain
,
Manuel Rodriguez-Tellez
2   Department of Digestive Diseases, Virgen Macarena University Hospital, Seville, Spain
3   Digestive Endoscopy Unit, Hospital San Agustin, Seville, Spain
,
Juan Carlos Gómez-Rosado
1   Colorectal Surgery Unit, Virgen Macarena University Hospital, Seville, Spain
,
Fernando Oliva Mompean
1   Colorectal Surgery Unit, Virgen Macarena University Hospital, Seville, Spain
› Institutsangaben

There are many alternatives for minimally invasive treatment of early colorectal lesions in the rectum. Endoscopic approaches include endoscopic mucosal resection (EMR), endoscopic submucosal resection (ESR), or endoscopic full-thickness resection (eFTR) using the full-thickness resection device (FTRD; Ovesco), which is an alternative after incomplete endoscopic resection, in high risk patients, and for lesions with difficult endoscopic access [1]. Minimally invasive surgical alternatives, such as transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS), are also available [2] [3].

We present the case of a 72-year-old woman under investigation by the gastroenterologist for gastrointestinal disorders. A colonoscopy was performed, which revealed a non-invasive adenomatous lesion, in the form of a laterally spreading tumor (LST) type IIa + Is, arising from the anterior rectal wall, 8 cm from the anal verge, and occupying 60 % of the lumen. Mucosectomy with piecemeal resection was carried out, with pathological examination of the specimen reporting high grade dysplasia.

A new colonoscopy was performed and a fibrotic lesion was resected using the FTRD ([Fig. 1 a]), revealing a tubulovillous adenoma with low grade dysplasia. Further endoscopic follow-up showed the metal device (FTRD clip) located on the anterior middle rectal wall and covered with adenomatous tissue ([Fig. 1 b]). A biopsy was taken and the report showed a tubulovillous adenoma with high grade dysplasia.

Zoom Image
Fig. 1 Colonoscopic views showing: a a rectal polyp; b the previously applied full-thickness resection device covered with adenomatous tissue.

The patient was discussed with the surgical team, and TAMIS was performed ([Video 1]), with the free margins being marked ([Fig. 2 a]), before full-thickness rectal wall resection ([Fig. 2 b]), followed by closure of the defect.

Video 1 Transanal minimally invasive surgery after incomplete resection of a rectal polyp using a full-thickness resection device.


Qualität:
Zoom Image
Fig. 2 Views during transanal minimally invasive surgery (TAMIS) showing: a the free margins being marked; b full-thickness resection.

Pathological analysis showed a 3.5 × 2.3 × 1.1-cm specimen, containing a 1.5 × 1.5-cm lesion with a metal device within it. A tubular adenoma with low grade dysplasia and free margins was confirmed.

The patient’s postoperative recovery was uneventful and no signs of recurrence were found on follow-up after 6 months.

TAMIS is an alternative for failed or incomplete resection after eFTR using the FTRD. It is a safe and feasible technique allowing for a full-thickness rectal resection [4] [5].

Endoscopy_UCTN_Code_CPL_1AJ_2AD

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Publikationsverlauf

Artikel online veröffentlicht:
05. Juni 2020

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