LATERALLY SPREADING TUMOR EXTENDING TO THE DENTATE LINE: CHALLENGES OF ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD)

82-year-old male referred due to a 56mm nodular-mixed type laterally-spreading tumour, Paris 0-Is+IIa, JNET type-2B, located in the distal rectum, extending to the anal verge.

Endoscopic submucosal dissection (ESD) initiated with incision distal to the anal verge, involving 50% of its circumference, followed by the creation of a tunnel in an oral direction. A proximal mucosal incision was made to establish the tunnel´s endpoint. Progressive widening of the tunnel was performed until complete en bloc resection.

Rectal tumors extending to the dentate line are demanding to remove. Combination of anoderm incision, tunnel creation and retroversion allows en bloc ESD.

Publication History

Article published online:
14 April 2022