Open Access
CC BY 4.0 · Endoscopy 2025; 57(S 01): E1068-E1069
DOI: 10.1055/a-2686-3672
E-Videos

Internal traction combined with underwater endoscopic submucosal dissection for a rectal neuroendocrine tumor

Authors

  • Juan Cao

    1   Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China (Ringgold ID: RIN12387)
  • Yang Song

    1   Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China (Ringgold ID: RIN12387)
  • De-Feng Li

    1   Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China (Ringgold ID: RIN12387)
  • Jun Yao

    1   Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China (Ringgold ID: RIN12387)
  • Ruiyue Shi

    1   Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China (Ringgold ID: RIN12387)
  • Li-Sheng Wang

    1   Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China (Ringgold ID: RIN12387)
  • Shenggang Zhan

    1   Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China (Ringgold ID: RIN12387)

Supported by: Science and Technology Innovation Committee of Shenzhen JCYJ2022053015180024
Supported by: Science and Technology Innovation Committee of Shenzhen JCYJ20210324113802006
 

Underwater endoscopic submucosal dissection (ESD) has the advantages of a clear endoscopic view and easy manipulation by buoyancy in the removal of gastrointestinal tract lesions [1]. In addition, some cases reported that traction combined with underwater ESD improved visual acuity in the removal of early pharyngeal cancer and colorectal sessile serrated adenoma/polyp [2] [3]. Herein, we showed a case with a rectal neuroendocrine tumor (NET), which was successfully removed by internal traction combined with underwater ESD.

A 59-year-old female was diagnosed with a rectal NET during colorectal cancer screening examination ([Fig. 1] a). Endoscopic ultrasonography (EUS) showed a hypoechoic lesion (8.3 mm × 6.6 mm) originating from the submucosa layer ([Fig. 1] b). “Clip coupled with elastic ring” internal traction according to our previous study combining with underwater ESD was performed to resect the rectal NET [4]. The routine procedures involving marking the lesion, submucosal injection, circumferential incision, and clip, coupled with elastic ring internal traction, were performed ([Fig. 1] c–f). Then, dissection was conducted with underwater saline immersion ([Fig. 1] g and [Video 1]). The lesion was successfully removed with en bloc resection, and histopathology demonstrated a neuroendocrine tumor ([Fig. 1] h, i). The defect was closed with endoscopic clips ([Fig. 1] j). The internal traction combined with underwater ESD may overcome the disadvantages of conventional or traction strategies in the treatment of rectal NET, such as poor visual field, deep thermal injury, and iatrogenic perforation risk. Moreover, this simple method may facilitate a constant endoscopic view and smooth continuation during the procedure; however, further studies are needed.

Zoom
Fig. 1 a A rectal NET was diagnosed during colorectal cancer screening examination. b EUS showed a hypoechoic lesion originating from the submucosa layer. c Circumferential marking was performed 5 mm outside the edge of the lesion. d Submucosal injection was performed around the lesion. e Circumferential mucosal incision was made outside the marked area. f Clip coupled with elastic ring internal traction was performed. g Dissection was conducted with underwater saline immersion. h The resected tumor specimen. i Histopathology demonstrated a neuroendocrine tumor. j The defect was sutured with endoscopic clips.
The procedure of internal traction combined with underwater endoscopic submucosal dissection for a rectal neuroendocrine tumor.Video 1

Endoscopy_UCTN_Code_TTT_1AQ_2AD_3AZ

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Conflict of Interest

The authors declare that they have no conflict of interest.


Correspondence

Shenggang Zhan
Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology)
No. 1017, Dongmen North Road
518020Shenzhen
China   

Publication History

Article published online:
11 September 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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Zoom
Fig. 1 a A rectal NET was diagnosed during colorectal cancer screening examination. b EUS showed a hypoechoic lesion originating from the submucosa layer. c Circumferential marking was performed 5 mm outside the edge of the lesion. d Submucosal injection was performed around the lesion. e Circumferential mucosal incision was made outside the marked area. f Clip coupled with elastic ring internal traction was performed. g Dissection was conducted with underwater saline immersion. h The resected tumor specimen. i Histopathology demonstrated a neuroendocrine tumor. j The defect was sutured with endoscopic clips.