Work

Saline-tunneling endoscopic submucosal dissection for residual rectal lesion at anastomotic staple line

Year: 2025

Type: article

Abstract: Background and Aims: Endoscopic submucosal dissection (ESD) in surgically altered colorectal anatomy is challenging because of postsurgical fibrosis and the presence of staples. We report a case of a combined saline immersion and tunneling ESD ("saline-tunneling" ESD) for a lesion at a stapled rectal anastomosis. Methods: F-fluorodeoxyglucose positron emission tomography/computed tomography scan showed a non-fluorodeoxyglucose-avid soft-tissue mass just above the anastomosis without nodal or distant metastases. Colonoscopy revealed a 3.5-cm granular, mixed-nodular laterally spreading tumor spanning the anastomotic staple line. Near-focus magnifying endoscopy narrow-band imaging with indigo carmine showed Kudo V_i and Japan Narrow-Band Imaging Expert Team 2B features consistent with advanced neoplasia. We performed saline-tunneling ESD under continuous saline immersion to enhance visualization, stability, and margin acquisition. Results: En bloc resection of the lesion was achieved. Histopathology confirmed a tubulovillous adenoma with high-grade dysplasia and negative margins. Conclusions: This case demonstrates the successful integration of submucosal tunneling and saline immersion techniques at a stapled rectal anastomosis. The novel saline-tunneling ESD approach may offer a safe, effective alternative to repeat surgery for fibrotic, anatomically constrained colorectal lesions.

Source: VideoGIE

DOI: 10.1016/j.vgie.2025.10.005

Authors: Taranika Sarkar Das, Prabhleen Chahal, Matheus Franco

Institutions: Brooklyn Hospital Center, The University of Texas at San Antonio Health Science Center

Language: English

Topic: Colorectal Cancer Screening and Detection

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,000