ABSTRACT
The detection rate of dysplastic colorectal polyps has significantly increased with improved screening programs. Treatment of dysplastic polyps attempt to limit morbidity of a procedure while also considering the risk of occult lymph node metastasis. Therefore, a variety of methods have been developed to predict the rate of lymph node metastasis to help identify the optimal treatment of patients. These include both the endoscopic and pathologic assessment of the lesion. In order to reduce the morbidity of surgery for patients with low-risk lesions, multiple endoscopic therapies have been developed, including endoscopic mucosal resection, endoscopic submucosal dissection, endoscopic intermuscular dissection, and transanal endoscopic surgery.
Subject(s)
Colonic Polyps , Colorectal Neoplasms , Humans , Colorectal Neoplasms/pathology , Colorectal Neoplasms/therapy , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/surgery , Colonic Polyps/surgery , Colonic Polyps/pathology , Colonic Polyps/diagnosis , Colonoscopy/methods , Endoscopic Mucosal Resection/methodsABSTRACT
In the current era of screening colonoscopy and increasing incidence of early rectal cancer, interventional endoscopy moves toward resections in deeper planes than the submucosal layer. Several reports support the use of endoscopic intermuscular dissection (EID) instead of endoscopic submucosal dissection (ESD) for the removal of deeply invasive rectal submucosal cancers. The resection plane into the intermuscular space, the space between the longitudinal (external) and circular (internal) muscle layer, allows radical removal of rectal invasive submucosal cancers. Furthermore, the technique offers the potential for dissection of scarred and severe fibrotic lesions in the rectum by cutting deeper and performing a partial myectomy avoiding the narrow submucosal space. We present 23 cases of EIDs both for deeply invasive rectal cancers and benign rectal lesions. This is the first report in the literature of EID resections for malignant and benign disease, including cases of severely fibrotic rectal lesions.
Subject(s)
Endoscopic Mucosal Resection , Rectal Neoplasms , Humans , Rectum/surgery , Rectum/pathology , Rectal Neoplasms/surgery , Rectal Neoplasms/pathology , Colonoscopy/methods , Dissection/methods , Pelvis/pathology , Endoscopic Mucosal Resection/methods , Treatment OutcomeABSTRACT
Video 1Video demonstration of endoscopic intermuscular dissection with intermuscular tunneling.