ENDOSCOPIC PIECE MEAL MUCOSAL RESECTION OF LARGE GRANULAR LATERALLY SPREADING TUMOR OF SIGMOID COLON WITHOUT POSTPROCEDURAL LOCAL RESIDUAL NEOPLASIA

Up to 80% of colorectal carcinomas originate from an adenoma polyp or non-polypoid adenoma lesion. There are various therapeutic endoscopic methods with curative potential. Screening of colorectal cancer has been introduced in the Czech Republic and led to a 17.5% decrease in mortality and a 2.2% decrease of incidence of colorectal cancer (data from 2003 to 2013). Endoscopic therapy of precancerous lesions is the key to successful therapy. The basic goal is R0 resection, it means complete histological eradication of this pathological lesions with negative edges and base of the resected tissue. According to recent studies, “en block” resection is associated with a lower incidence of local residual neoplasia (LRN) (3%) than piece meal resection (20%). But very important is precise macroscopic evaluation of the lesion and, in particular, the evaluation of the base after therapeutic eradication. If the place after resection is macroscopically without residuals, then a complete resection can be expected. Large laterally spreading tumors (LST) over 5 cm can be effectively treated by piece meal endoscopic resection. All polyps according to the Paris classification 0-Is and especially LST class IV and less according to Kudo (pit pattern) classification, that do not extend to submucosal layer, are very suitable for this type of therapy. In this case, endoscopic piece meal resection (EPMR) is more effective than endoscopic submucosal dissection ESD even if “en block” resection is not possible. This approach is fast, technically feasible, sufficiently radical and safe. We are demonstrating video case report of a large mixed granular semicircular LST of sigmoid colon, size 8 × 5 cm, histologically tubulovillous adenoma with HGIN, which was curatively resected by EPMR within 1.5 hours. Despite its size, we achieved complete macroscopic and histological resection. After three months, a scar without LRN or significant stenosis was observed.