First report from the International Evaluation of Endoscopic classification Japan NBI Expert Team: International multicenter web trial.

OBJECTIVES: Narrow-band imaging (NBI) contributes to real-time optical diagnosis and classification of colorectal lesions. The Japan NBI Expert Team (JNET) was introduced in 2011. The aim of this study was to explore the diagnostic accuracy of JNET when applied by European and Japanese endoscopists not familiar with this classification. METHODS: This study was conducted by 36 European Society of Gastrointestinal Endoscopy (ESGE) and 49 Japan Gastroenterological Endoscopy Society (JGES) non-JNET endoscopists using still images of 150 lesions. For each lesion, nonmagnified white-light, nonmagnified NBI, and magnified NBI images were presented. In the magnified NBI, the evaluation area was designated by region of interest (ROI). The endoscopists scored histological prediction for each lesion. RESULTS: In ESGE members, the sensitivity, specificity, and accuracy were respectively 73.3%, 94.7%, and 93.0% for JNET Type 1; 53.0%, 64.9%, and 62.1% for Type 2A; 43.9%, 67.7%, and 55.1% for Type 2B; and 38.1%, 93.7%, and 85.1% for Type 3. When Type 2B and 3 were considered as one category of cancer, the sensitivity, specificity, and accuracy for differentiating high-grade dysplasia and cancer from the others were 59.9%, 72.5%, and 63.8%, respectively. These trends were the same for JGES endoscopists. CONCLUSION: The diagnostic accuracy of the JNET classification was similar between ESGE and JGES and considered to be sufficient for JNET Type 1. On the other hand, the accuracy for Types 2 and 3 is not sufficient; however, JNET 2B lesions should be resected en bloc due to the risk of cancers and JNET 3 can be treated by surgery due to its high specificity.

[A Case of Synchronous Solitary Splenic Metastasis of Sigmoid Colon Cancer Treated with Laparoscopic Resection].

An 82-year-old woman presented to our hospital with chief complaints of lower abdominal pain and nausea. Contrast- enhanced CT showed ileus of sigmoid colon cancer and a solitary splenic tumor. A metallic stent was placed for the primary lesion. FDG-PET showed high FDG accumulation in the solitary splenic tumor, and synchronous solitary splenic metastasis was diagnosed. Laparoscopic sigmoid colectomy and laparoscopic splenectomy were performed without changing the intraoperative position or port arrangement. Postoperative progress was favorable. The patient was discharged 9 days after surgery, and no sign of recurrence has been observed to date, at 4 months after surgery. Solitary splenic metastasis of colorectal cancer is extremely rare. This is the first case report of synchronous solitary splenic metastasis of colorectal cancer treated with laparoscopic resection in Japan. This procedure is considered effective and minimally invasive. We review and discuss the Japanese literature on this rare disease.

[A Case Report of Postoperative Chylous Ascites after Laparoscopic Sigmoidectomy].

A female in her 70s was diagnosed as sigmoid colon cancer. Laparoscopic sigmoidectomy was performed. Chylous ascites was observed after starting oral intake. As we changed the patient's diet to a low fat diet, the chylous ascites disappeared. There are certain numbers of reports of the cases improved by fasting or only fat decreased meal. It is important to prevent this complications using appropriate surgical devices.

[Multiple Cysts Formation in Pulmonary Light Chain Deposition Disease(LCDD)-A Case Report].

AIM: To review the clinical features of the patient with cystic pulmonary light chain deposition disease(LCDD)and record high-resolution CT and histopathological findings. PATIENT: A 60-year-old woman who diagnosed multiple myeloma was admitted. There were diffuse proliferation of plasma cells by the bone marrow puncture that she received. And multiple cystic pulmonary tumors found in CT. We analyzed the method and result of the diagnosis. CT showed multiple cystic pulmonary tumors in the both lung which vessels traversing the cysts with thin wall ranged 5 to 30 millimeters. There were no abnormality in the heart, kidney and liver. Right upper lobe wedge resection was performed via video-assisted thoracic surgery( VATS)to establish a definitive diagnosis. Thoracoscopic findings revealed multiple white oval formed tumors in the visceral pleura. Histological HE staining findings of the surgical specimen revealed amyloid-like acidophilic material, and the immunohistochemical Congo red staining revealed monoclonal IgG with a kappa component. According to the above results these tumors had a diagnosis of pulmonary LCDD. CONCLUSION: VATS was effective to diagnose pulmonary LCDD in multiple cysts formation.

[A Case of Synchronous Double Lung Cancer Including Intestinal Adenocarcinoma Complicated with Colonic Adenoma].

The patient was a 73-year-old man who was referred to our hospital for increasing bilateral lung nodules. Video-assisted left S9-10 segmentectomy and right S1, S3 partial resection were performed separately for suspect of synchronous double lung cancer. Colonoscopy was performed because left lung tumor was difficult to distinguish between primary lung cancer and metastatic lung cancer. Colonoscopy did not find advanced cancer lesion. We diagnosed the left lung tumor as pT1b, cN0, cM0, Stage ⅠA2 intestinal adenocarcinoma. The right lung tumor was diagnosed as pT1c, cN0, cM0, Stage ⅠA3 papillary adenocarcinoma. Intestinal adenocarcinoma is a rare tissue subtype of lung adenocarcinoma and colonoscopy is useful modality for ruling out metastatic colorectal cancer.

Case of Invasive Streptococcus Dysgalactiae Infection Presenting as Infective Endocarditis with Multiple Brain Embolisms.

A 65-year-old Japanese man complaining of general malaise and presenting with high fever was admitted to our hospital. He had untreated diabetes and hepatocellular carcinoma with liver cirrhosis. Overall findings of the patient indicated sepsis. Two blood cultures were positive for Streptococcus dysgalactiae, a group C or G Streptococcus. Transthoracic and transesophageal echocardiography revealed vegetations on the aortic and mitral valves. Although antimicrobial therapy with aminobenzyl penicillin was effective for controlling infection, multiple cerebral embolisms occurred in the clinical course of the disease. Primary care doctors should consider invasive Streptococcus dysgalactiae infections when treating elderly patients with underlying diseases, and Streptococcus dysgalactiae should be included in the list of microorganisms considered to cause endocarditis in such patients.

[Assessment of Prognosis after Surgical Treatment for Colorectal Liver Metastasis Using a Nomogram].

A nomogram is a statistical tool that can provide the specific outcomes of individual patients. In this study, we used a nomogram developed by Beppu et al to evaluate the prognoses of 38 patients who underwent hepaticresec tion at our hospital. This nomogram predicts disease-free survival(DFS)after hepatic resection for colorectal liver metastasis based on 6 clinical and oncological factors. Using this nomogram, we divided the 38 patients into 3 groups: Group N, actual DFS was almost similar to the estimated median DFS(EMDFS)provided by the nomogram; Group A, DFS was longer than EMDFS; and Group B, DFS was shorter than EMDFS. Then, we compared and analyzed clinical and oncological factors between Groups A and B. Group B patients tended to have single metastasis and non-normal levels of CA19-9. Besides, Group B patients had DFS shorter than approximately 2 years. These results suggest that if CA19-9 levels are not normalized after hepaticresec tion for single metastasis, we should consider careful observation and adjuvant chemotherapy for potential micrometastasis.

[A Case of Appendiceal Neuroendocrine Tumor Diagnosed after Appendectomy].

A 25-year-old woman visited our hospital with a complaint of right lower abdominal pain. As a result of the examination, she was diagnosed as having acute appendicitis. After conservative treatment, we planned an elective surgery. At 3 months after discharge, laparoscopic appendectomy was performed. We found a mass of 10mm in diameter at the body of the appendix. Histopathological examination revealed the proliferation of heteromorphic cells with small round nuclei. It was positive for chromogranin A and synaptophysin in immunostaining, so we made a diagnosis of NET G1. Tumor cells infiltrated beyond the intrinsic muscle layer, but no vascular invasion was observed, and the margin was negative. In accordance with the guidelines, we followed up the patient with imaging examination and did not find any signs of recurrence.

Validation study for development of the Japan NBI Expert Team classification of colorectal lesions.

BACKGROUND AND AIM: The Japan narrow-band imaging (NBI) Expert Team (JNET) was organized to unify four previous magnifying NBI classifications (the Sano, Hiroshima, Showa, and Jikei classifications). The JNET working group created criteria (referred to as the NBI scale) for evaluation of vessel pattern (VP) and surface pattern (SP). We conducted a multicenter validation study of the NBI scale to develop the JNET classification of colorectal lesions. METHODS: Twenty-five expert JNET colonoscopists read 100 still NBI images with and without magnification on the web to evaluate the NBI findings and necessity of the each criterion for the final diagnosis. RESULTS: Surface pattern in magnifying NBI images was necessary for diagnosis of polyps in more than 60% of cases, whereas VP was required in around 90%. Univariate/multivariate analysis of candidate findings in the NBI scale identified three for type 2B (variable caliber of vessels, irregular distribution of vessels, and irregular or obscure surface pattern), and three for type 3 (loose vessel area, interruption of thick vessel, and amorphous areas of surface pattern). Evaluation of the diagnostic performance for these three findings in combination showed that the sensitivity for types 2B and 3 was highest (44.9% and 54.7%, respectively), and that the specificity for type 3 was acceptable (97.4%) when any one of the three findings was evident. We found that the macroscopic type (polypoid or non-polypoid) had a minor influence on the key diagnostic performance for types 2B and 3. CONCLUSION: Based on the present data, we reached a consensus for developing the JNET classification.

[Urinary Retention Caused by Necrotic Tissues in the Bladder of a Female Recipient of a Living-Donor Kidney Transplant : A Case Report].

We report a patient who developed urinary retention due to the presence of necrotic tissues in the bladder 5 months after kidney transplantation. The patient was a 47-year-old female who had been diagnosed with immunoglobulin A nephropathy. She requested to receive a living-donor kidney transplant from her husband, and was referred to our hospital. Given that the patient had anuria preoperatively, her bladder capacity was presumed to have decreased following the transplantation. There were no events regarding vascular anastomosis during the surgery. However, since ureteroneocystostomy was difficult to perform due to the thinning of the bladder wall, the recipient's own ureter was anastomosed to the ureter of the transplanted kidney. Since the patient had difficulty voiding soon after the indwelling urinary catheter was removed, clean intermittent self-catheterization was initiated. Abdominal computed tomography revealed perforation of the bladder and extravesical urinary leakage on postoperative day 15. An indwelling urinary catheter was reinserted as conservative treatment. We removed the indwelling urinary catheter on postoperative day 25. The patient was discharged on postoperative day 30. Five months after transplantation, the patient suddenly developed urinary retention. Cystoscopy revealed some tissue hanging from the anterior wall of the bladder. The tissue was removed, and her voiding function improved. On pathology, the tissue was found to be non-specific necrotic tissue. This finding suggested that the necrotic tissue had caused urinary retention 5 months after transplantation. The symptoms of urinary retention markedly improved after the treatment.

Lattice and Valence Electronic Structures of Crystalline Octahedral Molybdenum Halide Clusters-Based Compounds, Cs2[Mo6X14] (X = Cl, Br, I), Studied by Density Functional Theory Calculations.

The electronic and crystal structures of Cs2[Mo6X14] (X = Cl, Br, I) cluster-based compounds were investigated by density functional theory (DFT) simulations and experimental methods such as powder X-ray diffraction, ultraviolet-visible spectroscopy, and X-ray photoemission spectroscopy (XPS). The experimentally determined lattice parameters were in good agreement with theoretically optimized ones, indicating the usefulness of DFT calculations for the structural investigation of these clusters. The calculated band gaps of these compounds reproduced those experimentally determined by UV-vis reflectance within an error of a few tenths of an eV. Core-level XPS and effective charge analyses indicated bonding states of the halogens changed according to their sites. The XPS valence spectra were fairly well reproduced by simulations based on the projected electron density of states weighted with cross sections of Al Kα, suggesting that DFT calculations can predict the electronic properties of metal-cluster-based crystals with good accuracy.

Cytomegalovirus peritonitis after kidney transplantation diagnosed through histopathological examination.

Among organ transplant recipients, cytomegalovirus (CMV) commonly results in various types of infection such as pneumonitis, hepatitis, and enterocolitis. However, CMV peritonitis is very rare and difficult to diagnose owing to lack of visible clinical signs. We present a case of a 35-year-old female kidney recipient who developed abdominal pain and urinary retention caused by CMV peritonitis. To our knowledge, this is the first case report of CMV peritonitis after organ transplantation to be diagnosed through histopathological examination.

Atrophic bladder in long-term dialysis patients increases the risk for urological complications after kidney transplantation.

OBJECTIVES: To evaluate the risk for urological complications after kidney transplantation at a single medical center in Japan. METHODS: In the present study, 408 kidney recipients (255 men, 153 women) were enrolled. There were 349 living and 59 deceased donors. The average age of the recipients was 42.5 ± 13.5 years, and the average pretransplant dialysis period was 71.8 ± 88.2 months. Ureteroneocystostomy was carried out on 347 patients, and ureteroureterostomy on 61 patients. We investigated the relationship between pretransplant duration of dialysis and bladder capacity, and examined the risk factors for urological complication. We also evaluated the incidence of vesicoureteral reflux in 191 recipients who underwent ureteroneocystostomy during transplantation. RESULTS: The preoperative duration of dialysis therapy showed a significant negative correlation with bladder capacity (R2  = 0.33, P < 0.001). The overall urological complication rate was 3.4% (14 patients), including urinary leakage (12 patients) and ureteral stricture (two patients). Univariate analysis showed that atrophic bladder, long-term dialysis therapy, deceased donor and ureteroureterostomy were associated with a higher incidence of urological complications (odds ratio 8.05, 4.43, 3.42 and 3.35; P < 0.01, P = 0.01, P = 0.04 and P = 0.04, respectively). Furthermore, multivariate analysis showed that atrophic bladder was the only significant factor associated with urological complications (odds ratio 10.37; P = 0.01). Among 191 recipients, vesicoureteral reflux was observed in 32 (16.8%). The incidence of vesicoureteral reflux was significantly higher in patients with atrophic bladder. CONCLUSIONS: Bladder atrophy in renal transplant recipients after long-term dialysis therapy is associated with a higher risk of urological complications.

Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team.

Many clinical studies on narrow-band imaging (NBI) magnifying endoscopy classifications advocated so far in Japan (Sano, Hiroshima, Showa, and Jikei classifications) have reported the usefulness of NBI magnifying endoscopy for qualitative and quantitative diagnosis of colorectal lesions. However, discussions at professional meetings have raised issues such as: (i) the presence of multiple terms for the same or similar findings; (ii) the necessity of including surface patterns in magnifying endoscopic classifications; and (iii) differences in the NBI findings in elevated and superficial lesions. To resolve these problems, the Japan NBI Expert Team (JNET) was constituted with the aim of establishing a universal NBI magnifying endoscopic classification for colorectal tumors (JNET classification) in 2011. Consensus was reached on this classification using the modified Delphi method, and this classification was proposed in June 2014. The JNET classification consists of four categories of vessel and surface pattern (i.e. Types 1, 2A, 2B, and 3). Types 1, 2A, 2B, and 3 are correlated with the histopathological findings of hyperplastic polyp/sessile serrated polyp (SSP), low-grade intramucosal neoplasia, high-grade intramucosal neoplasia/shallow submucosal invasive cancer, and deep submucosal invasive cancer, respectively.

Endocytoscopic microvasculature evaluation is a reliable new diagnostic method for colorectal lesions (with video).

BACKGROUND: We previously reported on the efficacy of endocytoscopic classification (EC-C). However, the correlation of the endocytoscopic vascular (EC-V) pattern with diagnoses was unclear. OBJECTIVE: To assess the diagnostic accuracy of the EC-V pattern for colorectal lesions. DESIGN: Retrospective. SETTING: A university hospital. PATIENTS: Patients who underwent endocytoscopy between January 2010 and March 2013. INTERVENTION: We evaluated 198 consecutive lesions according to the EC-V pattern (EC-V1, obscure surface microvessels; EC-V2, clearly observed surface microvessels of a uniform caliber and arrangement; and EC-V3, dilated surface microvessels of a nonhomogeneous caliber or arrangement). MAIN OUTCOME MEASUREMENTS: The diagnostic accuracy for predicting hyperplastic polyps and invasive cancer were compared between the EC-V pattern and other modalities (narrow-band imaging, pit pattern, and EC-C). RESULTS: The sensitivity, specificity, and accuracy of the EC-V1 pattern for diagnosing hyperplastic polyps were 95.5%, 99.4%, and 99.0%, respectively. The sensitivity, specificity, and accuracy of the EC-V3 pattern for diagnosing invasive cancer were 74.6%, 97.2%, and 88.6%, respectively. The diagnostic accuracy of the EC-V pattern for predicting hyperplastic polyps was comparable to the other modalities. For predicting invasive cancer, the EC-V pattern was comparable to narrow-band imaging and pit pattern, although EC-C was slightly more accurate (P = .04). In the substudy, the diagnosis time by using the EC-V pattern was shorter than that with the EC-C pattern (P < .001). LIMITATIONS: A single-center, retrospective study. CONCLUSIONS: The EC-V pattern saved more time than the EC-C pattern and had a diagnostic ability comparable to that of other optical biopsy modalities.

Plasmon-mediated photocatalytic activity of wet-chemically prepared ZnO nanowire arrays.

We report on measurements and simulations of the efficient sunlight-driven and visible-active photocatalysts composed of plasmonic metal nanoparticles and ZnO nanowire (NW) arrays fabricated via an all-wet-chemical route. Because of the coupling between the ZnO dielectric response and the excitation of the Ag or Au nanoparticles, efficient electronic excitation can be induced in the vicinity of the metal-ZnO interfaces because optically-excited plasmonic particles can not only concentrate the electromagnetic field at the ZnO/particle interface, but also act as efficient sources of plasmonic hot electrons to be injected into the conduction band of the ZnO catalyst. The catalytic activities of the fabricated ZnO NWs are examined by photodegradation of methylene blue and by photocurrent measurements in a photovoltaic configuration. Numerical electromagnetic simulations were used to understand the behavior of the light on the nanometer-scale to clarify the catalytic enhancement mechanisms in both the ultraviolet (UV) and visible (VIS) regions. In addition, simulation results indicated that a near-surface normal but slightly tilted ZnO NW array geometry would provide an increased optical path length and enhanced multiple scattering and absorption processes arising from the localized surface plasmon resonances of the nanoparticles. The results obtained here clarify the role of the plasmon resonance and provide us with useful knowledge for the development of metal-oxide nano-hybrid materials for solar energy conversion.

Predictive factors for complications in endoscopic resection of large colorectal lesions: a multicenter prospective study.

BACKGROUND AND STUDY AIMS: Conventional endoscopic resection (CER) includes polypectomy and endoscopic mucosal resection. The most common complications related to these techniques are post procedure bleeding and perforation. The aim of this study was to evaluate the outcomes of CER for colorectal neoplasms ≧20 mm and to clarify predictive factors for complications. PATIENTS AND METHODS: We conducted a multicenter prospective study at 18 specialized institutes. From October 2007 to December 2010, 1,029 CERs were performed at participating institutes. We collected the data prospectively and analyzed gender, age, tumor size, gross appearance, mode of resection, etc. RESULTS: The mean size of polyps resected was 26.4 ± 8.6 mm (range 20-120 mm). The final pathology was Vienna classification category 1 or 2 in 24, category 3 in 502, and category 4 or 5 in 503 lesions. Post procedure bleeding and intra procedure perforation occurred, respectively, in 16 (1.6%) and 8 cases (0.78%). The overall complication rate was 2.3%. Risk factors for bleeding in multivariate analysis were only patients under 60 years of age. Risk factors for perforation in multivariate analysis were en bloc resection and Vienna classification category 4-5. The difference of complication rate was not statistically significant regarding gender, size, tumor location, gross appearance, treatment method, and kind of insufflation. CONCLUSION: CER is a safe, efficient, and effective minimally invasive therapy for large colorectal lesions. However, care should be taken for post procedure bleeding in patients under 60 years of age and for perforation in cases of Vienna classification category 4-5 or when an en bloc resection is tried.

Efficiency of endocytoscopy in differentiating types of serrated polyps.

BACKGROUND: Accurate endoscopic criteria are needed to differentiate serrated polyps, including hyperplastic polyp (HP), sessile serrated adenoma/polyp (SSA/P), and traditional serrated adenoma (TSA), because some are precursors of colorectal cancers. OBJECTIVE: To determine the endocytoscopic features of each type of serrated polyp, especially the shapes of lumens and nuclei. DESIGN: Retrospective study. SETTING: Single, tertiary-care referral center. PATIENTS: Patients who underwent removal of serrated polyps from May 2005 to December 2012. INTERVENTION: Endocytoscopy was performed. Endocytoscopic images were evaluated by assessing the shapes of the lumens and nuclei of the target lesions. MAIN OUTCOME MEASUREMENTS: The significant endocytoscopic features in differentiating among types of serrated polyps. RESULTS: Of the 58 eligible lesions, 27 were classified as HP, 12 as SSA/P, and 19 as TSA. Most HPs (77.8%) had star-like lumens, and most SSA/Ps (83.3%) had oval lumens. The lumens of TSAs were serrated (31.6%) or villous (68.4%), with both shapes seen only in TSAs. Most HPs (92.6%) and SSA/Ps (75.0%) had small, round nuclei, and all TSAs had fusiform nuclei. Features significantly differentiating TSAs from HPs and SSA/Ps were the presence of fusiform nuclei (P < .001) and villous (P < .001) and serrated (P = .002) lumens. The presence of oval lumens was significantly characteristic of SSA/Ps (P < .001), and the presence of star-like lumens was significantly characteristic of HPs (P < .001). LIMITATIONS: Retrospective design. Single-center study. CONCLUSION: The shape of lumens and nuclei on endocytoscopy can efficiently differentiate among the different types of serrated polyps. ( CLINICAL TRIAL REGISTRATION NUMBER: UMIN Clinical Trials Registry UMIN000007850.).

Endocytoscopy can provide additional diagnostic ability to magnifying chromoendoscopy for colorectal neoplasms.

BACKGROUND AND AIM: Pit pattern (PIT) diagnosis with magnifying chromoendoscopy is effective diagnostic method for predicting a massively invasive submucosal colorectal cancer (SMm) which has possibility of metastasis, whereas endocytoscopy (EC) is recently reported to provide excellent diagnostic ability by enabling in vivo cellular visualization. The aim was to assess the additional diagnostic value of EC to PIT for diagnosing colorectal lesions. METHODS: We conducted a retrospective comparative analysis using a prospectively recorded database in a referral hospital. The subjects were 538 patients who were detected of a colorectal lesion with use of a magnifying colonoscope with EC capability. Each detected lesion was initially diagnosed by PIT findings followed by EC diagnosis by the on-site endoscopist. The diagnostic abilities in predicting neoplastic change and SMm were compared between PIT and PIT plus EC. RESULTS: Overall, 514 lesions from 455 patients were available for analysis. Of them, there were 58 non-neoplastic lesions, 352 adenomas, 15 slightly invasive submucosal cancers, and 89 SMm. The diagnostic abilities of predicting neoplastic change were comparable between PIT and PIT plus EC: sensitivity was 97.8% versus 97.4%, specificity was 91.4% versus 89.7%, and accuracy was 97.1% versus 96.5%. Regarding those of predicting SMm, PIT plus EC showed additional specificity and accuracy to PIT: specificity was 99.1% versus 97.6% (P = 0.041), and accuracy was 96.3% versus 93.8% (P = 0.004). CONCLUSIONS: Though PIT has feasible diagnostic ability for predicting both neoplastic change and SMm, EC provides additional diagnostic value to PIT diagnosis for predicting SMm.

Endoscopic submucosal dissection versus transanal endoscopic microsurgery for the treatment of early rectal cancer.

BACKGROUND: Endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) are minimally invasive procedures that can be used to treat early rectal cancer. OBJECTIVE: The aim of this study was to compare clinical efficacy between ESD and TEM for the treatment of early rectal cancer. METHODS: Between July 2008 and August 2011, 24 patients with early rectal cancers were treated by ESD (11) or TEM (13) at the Cancer Institute of São Paulo University Medical School (São Paulo, Brazil). Data were analyzed retrospectively according to database and pathological reports, with respect to en bloc resection rate, local recurrence, complications, histological diagnosis, procedure time and length of hospital stay. RESULTS: En bloc resection rates with free margins were achieved in 81.8 % of patients in the ESD group and 84.6 % of patients in the TEM group (p = 0.40). Mean tumor size was 64.6 ± 57.9 mm in the ESD group and 43.9 ± 30.7 mm in the TEM group (p = 0.13). Two patients in the TEM group and one patient in the ESD group had a local recurrence. The mean procedure time was 133 ± 94.8 min in the ESD group and 150 ± 66.3 min in the TEM group (p = 0.69). Mean hospital stay was 3.8 ± 3.3 days in the ESD group and 4.08 ± 1.7 days in the TEM group (p = 0.81). LIMITATIONS: This was a non-randomized clinical trial with a small sample size and selection bias in treatment options. CONCLUSION: ESD and TEM are both safe and effective for the treatment of early rectal cancer.