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CC BY 4.0 · Journal of Digestive Endoscopy 2025; 16(03): 169-171
DOI: 10.1055/s-0045-1810093
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Late Recurrence after Underwater EMR also Treated by Underwater EMR

Luciano Lenz 
1   Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
2   Department of Gastroenterology, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
3   Department of Gastroenterology, Fleury Medicina e Saúde, Brazil
,
Diego Cadena Aguirre
1   Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
,
Caio Perez
4   Department of Gastroenterology, Hospital Aliança D'or, Salvador, Brazil
5   Department of Gastroenterology, Hospital Português, Recife, PE, Brazil
6   Department of Gastroenterology, Hopistal Geral Roberto Santos, Salvador, BA, Brazil
,
Barbara Nascimento
7   Department of Pathology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
,
Adriana Vaz Safatle-Ribeiro
1   Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
8   Department of Gastroenterology, Hospital Sirio-Libanês, São Paulo, SP, Brazil
,
Ulysses Ribeiro Junior
1   Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
,
Fauze Maluf-Filho
1   Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
9   Department of Gastroenterology,National Council for Scientific and Technological Development - CNPq, Brasilia, Brazil
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Case Description

A 58-year-old male patient underwent an urgent Hartmann proctosigmoidectomy for obstructive neoplasia. Postoperative colonoscopy showed a granular homogeneous laterally spread tumor measuring 18 mm at the transverse colon. The lesion was removed by piecemeal underwater endoscopic mucosal resection (UEMR) without margin thermal ablation ([Fig. 1A–C]). No adverse events were observed. Histology revealed a tubulovillous adenoma with low-grade dysplasia ([Fig. 1D]). The patient was included in a clinical trial in our service (NCT03021135). According to the study protocol, a tattoo was done 3 cm distal to the lesion bed. At his 6-month surveillance colonoscopy, a scar was found at the site of resection. This scar was carefully examined using white light ([Fig. 2A]), narrow band imaging ([Fig. 2B]), and indigo carmine dye ([Fig. 2C]). No suspicious residual lesion was detected. Biopsies were negative for adenomatous tissue ([Fig. 2D]). Patient was lost after 1-year follow-up, returning 3 years after the first UEMR and 30 months after the first surveillance. This colonoscopy demonstrated an elevated lesion with a villous surface, measuring approximately 7 mm, along with the scar. New UEMR en bloc was performed ([Fig. 3A–C]). Histology confirmed tubulovillous adenoma with low-grade dysplasia ([Fig. 3D]). One year after the second UEMR, another surveillance colonoscopy revealed no residual lesion.

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Fig. 1 A A granular homogeneous laterally spread tumor measuring 18 mm at the transverse colon in the white light. (B) Lesion seen with indigo carmine. (C) Piecemeal UEMR procedure. (D) Histology revealed a tubulovillous adenoma with low-grade dysplasia.
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Fig. 2 A Scar carefully examined using white light. (B) Scar at narrow band imaging. (C) Indigo carmine dye using to examine the scar. (D) Biopsies negative for adenomatous tissue, with only fibrosis.
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Fig. 3 (A,B) An elevated lesion with villous surface. (C) After UEMR en bloc procedure. (D) Histology confirmed tubulovilllous adenoma with low-grade dysplasia.


Publication History

Article published online:
22 July 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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