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DOI: 10.1055/a-1174-6018
Transanal minimally invasive surgery after incomplete resection of a rectal polyp using a full-thickness resection device
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There are many alternatives for minimally invasive treatment of early colorectal lesions in the rectum. Endoscopic approaches include endoscopic mucosal resection (EMR), endoscopic submucosal resection (ESR), or endoscopic full-thickness resection (eFTR) using the full-thickness resection device (FTRD; Ovesco), which is an alternative after incomplete endoscopic resection, in high risk patients, and for lesions with difficult endoscopic access [1]. Minimally invasive surgical alternatives, such as transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS), are also available [2] [3].
We present the case of a 72-year-old woman under investigation by the gastroenterologist for gastrointestinal disorders. A colonoscopy was performed, which revealed a non-invasive adenomatous lesion, in the form of a laterally spreading tumor (LST) type IIa + Is, arising from the anterior rectal wall, 8 cm from the anal verge, and occupying 60 % of the lumen. Mucosectomy with piecemeal resection was carried out, with pathological examination of the specimen reporting high grade dysplasia.
A new colonoscopy was performed and a fibrotic lesion was resected using the FTRD ([Fig. 1 a]), revealing a tubulovillous adenoma with low grade dysplasia. Further endoscopic follow-up showed the metal device (FTRD clip) located on the anterior middle rectal wall and covered with adenomatous tissue ([Fig. 1 b]). A biopsy was taken and the report showed a tubulovillous adenoma with high grade dysplasia.
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The patient was discussed with the surgical team, and TAMIS was performed ([Video 1]), with the free margins being marked ([Fig. 2 a]), before full-thickness rectal wall resection ([Fig. 2 b]), followed by closure of the defect.
Video 1 Transanal minimally invasive surgery after incomplete resection of a rectal polyp using a full-thickness resection device.
Quality:
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Pathological analysis showed a 3.5 × 2.3 × 1.1-cm specimen, containing a 1.5 × 1.5-cm lesion with a metal device within it. A tubular adenoma with low grade dysplasia and free margins was confirmed.
The patient’s postoperative recovery was uneventful and no signs of recurrence were found on follow-up after 6 months.
TAMIS is an alternative for failed or incomplete resection after eFTR using the FTRD. It is a safe and feasible technique allowing for a full-thickness rectal resection [4] [5].
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Publication History
Article published online:
05 June 2020
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References
- 1 Soriani P, Tontini GE, Neumann H. et al. Endoscopic full-thickness resection for T1 early rectal cancer: a case series and video report. Endosc Int Open 2017; 5: E1081-E1086
- 2 Issa N, Fenig Y, Schmilovitz-Weiss H. et al. Simultaneous local excision of synchronous rectal polyps by transanal endoscopic microsurgery. Eur J Gastroenterol Hepatol 2020; 32: 45-47
- 3 Fukami N. Surgery versus endoscopic mucosal resection for large polyps: making sense of when to use which approach. Gastrointest Endosc Clin N Am 2019; 29: 675-685
- 4 Ono S, Kobayashi R, Ito S. et al. A case of successful full-thickness resection using endoscopic submucosal dissection and transanal suturing of rectal cancer. Endoscopy 2019; 51: E301-E302
- 5 De Jong GM, Hugen N. Minimally invasive transanal surgery is safe after incomplete polypectomy of low risk T1 rectal cancer: a systematic review. Colorectal Dis 2019; 21: 1112-1119