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Sparing of the rectum in Familial Adenomatous Polyposis: a difficult case of colorectal ESD - 1.º Classificado (Vídeo)
André Mascarenhas, Rui Mendo, Catarina O'Neill, Ana Rita Franco, Pedro Barreiro, Cristina Chagas
Hospital de Egas Moniz, CHLO
A 41-year-old male with familial adenomatous polyposis (FAP) was referred for endoscopic submucosal dissection (ESD) of a superficial neoplastic lesion that extended from the pectinate line to the sigmoid colon (longitudinal extension of 170 mm) and involved 70% of the circumference. In this video we demonstrate that ESD can be performed in exceedingly large colorectal lesions. Also, FAP patients who are candidates for rectal sparing should not be managed with proctocolectomy unless endoscopic management is unfeasible, as long as endoscopic surveillance of the residual rectum is performed. Histopathology confirmed R0 resection of a traditional serrated adenoma with focal high-grade dysplasia.