Korean J Gastroenterol.  2010 Sep;56(3):196-200. 10.4166/kjg.2010.56.3.196.

A Case of Synchronous Colonic Laterally Spreading Tumors Treated by Sequential Endoscopic Submucosal Dissection Performed on Two Consecutive Days

• Kim MJ
• Lee JE
• Kim SJ
• Kim KH
• Kim ES
• Cho KB
• Park KS

• KMID: 948782
• DOI: http://doi.org/10.4166/kjg.2010.56.3.196

Abstract

Endoscopic submucosal dissection (ESD) is an useful therapeutic technique for large gastrointestinal epithelial tumors that it provides an en bloc resection. Although there is some controversy about the role of ESD for colorectal lesions, for large lesions in the distal rectum, ESD has the advantage of preserving anal function. However, the large amount of insufflating gas used during the procedure can cause severe abdominal pain and discomfort. Moreover, high intra-luminal pressure caused by a by large amount of gas can cause a micro-perforation. There is no consensus as to whether ESD is the optimal treatment for synchronous large colorectal laterally spreading tumors (LSTs) that cannot be removed en-bloc by conventional endoscopic mucosal resection. Here, a case with two neighboring synchronous large LSTs, one located in the rectum and the other in the distal sigmoid colon, were sequentially removed by separate ESD procedures performed on two consecutive days in a patient who could not tolerate a long procedure.

Keyword

Colon; Synchronous; Laterally spreading tumor; Endoscopic submucosal dissection

MeSH Terms

Adenoma, Villous/diagnosis
Colonoscopy
Colorectal Neoplasms/*diagnosis/pathology/surgery
*Dissection
Humans
Intestinal Mucosa/pathology/surgery
Male
Middle Aged
Neoplasms, Multiple Primary/*diagnosis/pathology/surgery
Rectum/pathology

Figure

• 

  Fig. 1. Colonoscopy findings. (A) About a 3×4 cm glandular nodular type laterally spreading tumor was noted at the rectosigmoid junction. (B) About a 3×3 cm nodular type laterally spreading tumor was noted in the distal rectum, just above the den-tate line.

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  Fig. 2. Resected en bloc specimens. (A) The size of the rectosigmoid lesion was 4.0×3.1 cm. (B) The size of the distal rectal lesion was 4.0×3.7 cm.

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  Fig. 3. Microscopic findings. (A) Histologic examination of the rectosigmoid lesion showed a well differentiated adenocarcinoma arising from a serrated adenoma (Ki-67 stain, ×40). (B) Histologic examination of the distal rectal lesion showed focal adenocarcinoma arising from a tubulovillous adenoma with low grade dysplasia (Ki-67 stain, ×40).

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