Work

Underwater–assisted hybrid endoscopic submucosal dissection to ensure an adequate vertical margin for colorectal cancer with deep submucosal invasion

Year: 2026

Type: article

Abstract: Background and Aims Ensuring an adequate vertical margin (VM) is critical in endoscopic resection (ER) for T1 colorectal cancer (CRC). We aimed to demonstrate a novel underwater-assisted hybrid endoscopic submucosal dissection (ESD) strategy to optimize deep submucosal capture and ensure an adequate VM. Methods We performed underwater-assisted hybrid ESD for a 20-mm Paris type 0-IIa+IIc cecal lesion suspected of deep T1 CRC. After circumferential mucosal incision and circumferential submucosal dissection, the lumen was filled with saline. Additional submucosal injection and snaring under underwater condition were then performed to facilitate deep submucosal capture using the buoyancy effect. Results The lesion was successfully resected en bloc without adverse events. Histopathology revealed pT1b adenocarcinoma with a submucosal invasion depth of 2300 μm, negative horizontal and vertical margins, and a VM distance of 1020 μm. Conclusions Underwater-assisted hybrid ESD may represent one possible ER strategy for ensuring an adequate VM for T1b CRC ≤30 mm. When pathological evaluation reveals pT1b CRC, additional surgical management should generally be considered through multidisciplinary assessment, given the potential risk of lymph node metastasis.

Source: VideoGIE

DOI: 10.1016/j.vgie.2026.06.009

Authors: Yudai Takehara, Fumiaki Tanino, Masaki Wakai, Seiji Onogawa, Keiji Hanada, Shuji Yonehara

Institution: Onomichi General Hospital

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