Rectal laterally spreading tumors successfully treated in two steps by endoscopic submucosal dissection and endoscopic mucosal resection

BMC Gastroenterology

Case Report

Giovanni Milito¹  Federica Cadeddu¹  Italo Stroppa²  Raffaella Lionetti²  Francesco Pallone²  Giovanni Palmieri³ 

[1] Department of Surgery, Tor Vergata University, Rome, Italy;Gastrointestinal Unit, Department of Internal Medicine, Tor Vergata University, Rome, Italy;Pathology Unit, Department of Biopathology, Tor Vergata University, Rome, Italy;

关键词: Hyaluronic Acid;    Endoscopic Submucosal Dissection;    Endoscopic Mucosal Resection;    Bloc Resection;    Indigo Carmine;   

DOI  :  10.1186/1471-230X-10-135

 received in 2010-02-02, accepted in 2010-11-17,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundEndoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy alternative to endoscopic mucosal resection (EMR) for superficial gastrointestinal neoplasms >2 cm. ESD allows for the direct dissection of the submucosa and large lesions can be resected en bloc. ESD is not limited by resection size, increases histologically complete resection rates and may reduce the local recurrence.Nevertheless, the technique is time-consuming, technically demanding and associated with a high complication rate. To reduce the risk of complications, different devices and technical advances have been proposed with conflicting results and, still, ESD en bloc resections of huge lesions are associated with increased complications.Case PresentationWe successfully used a combined ESD/EMR technique for huge rectal laterally spreading tumors (LSTs). ESD was used for circumferential resection of 2/3 of the lesion followed by piecemeal resection (2-3 pieces) of the central part of the tumour.In all three patients we obtained the complete dissection of the polyp and the complete histological evaluation in absence of complications and recurrence at 6 months' follow up.ConclusionsIn the treatment of rectal LSTs, the combined treatment - ESD/EMR resection may be considered a suitable therapeutic option, indicated in selected cases as an alternative to surgery, in which the two techniques are neither reliable nor safe separately. However, to confirm our results, larger trials with longer follow up are required together with improvement of the technique and of the technical devices.

【 授权许可】

Unknown   
© Stroppa et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.