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Underwater endoscopic submucosal dissection of a relapsing neoplastic colorectal lesion after surgery and radiotherapy: water to the rescue!
Underwater endoscopic submucosal dissection of a relapsing neoplastic colorectal lesion after surgery and radiotherapy: water to the rescue!
André Mascarenhas, Pedro Barreiro, Nuno Figueiredo, Daniela Macedo, Cristina Chagas, David Serra
Centro Hospitalar de Lisboa Ocidental
A 69-year-old female presented tumoral relapse of a rectosigmoid adenocarcinoma at the colorectal anastomosis. After chemoradiotherapy and a watch-and-wait strategy, a 15-mm relapsing nonprotruding lesion was identified at the anastomosis. The patient was submitted to endoscopic submucosal dissection (ESD), which was extremely challenging due to the underlying fibrosis and the surgical material. Underwater ESD (U-ESD) allowed a safer and faster en bloc resection (R0 resection of a tubulovillous adenoma with low grade dysplasia). In this video we demonstrate the value of the recently described U-ESD, a procedure that was essential in order to achieve technical success and a curative resection.
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