Endoscopic submucosal dissection for residual rectal polyps embedded in tissue scar: a "rescue therapy" to prevent surgical intervention?

Caucasian woman with a 3.5 cm residual polyp embedded in tissue scar, as a result of three endoscopic piecemeal resection sessions of a 10 cm sessile polyp of the lower rectum, previously diagnosed from biopsy as tubulous−villous adenoma with high−grade dysplasia. The patient was then submitted to en bloc resection with endoscopic submuco− sal dissection (ESD) according to the tech− nique of Yamamoto [1,2] (l" Fig. 1 ± 3). The preparation of the patient consisted of mechanical bowel cleansing with poly− ethylene glycol solution and 5 days of oral antibiotic therapy with ciprofloxacin (500 mg twice daily) and metronidazole (500 mg three times daily). The procedure was carried out using a sin− gle−channel upper gastrointestinal endo− scope with a water−jet system (Olympus GIF 1T−160, Tokyo, Japan). A transparent cap (ST−HOOD, DH 15GR, Fujinon, Saita− ma, Japan) was attached to the tip of the endoscope in order to apply tension to the submucosal connective fibers during dissection (l" Fig. 4 ± 5). The procedure time was 2 hours. The postoperative course was uneventful and the patient was discharged 2 days after the procedure. The histological examination of the re− sected specimen described a residual adenomatous tissue with high−grade dys− plasia; the excision margins were nega− tive (R0 resection). The patient under− went control endoscopy 6 months later (l" Fig. 6), and multiple biopsies were Endoscopic submucosal dissection for residual rectal polyps embedded in tissue scar: a “rescue therapy” to prevent surgical intervention?