Año 2025 / Volumen 117 / Número 8
Carta
Endoscopic transmural resection as an alternative to colorectal surgery after high-risk (non-curative) endoscopic resection

473-474

DOI: 10.17235/reed.2024.10552/2024

Maria José Temido, Luís Santos, Elisa Gravito-Soares, Marta Gravito-Soares, Pedro Amaro, Maria Augusta Cipriano, Pedro Figueiredo,

Resumen
Endoscopic full-thickness resection (eFTR) is an emerging technique that enables effective and safe management of complex colorectal lesions. The full-thickness resection device (FTRD®, Ovesco, Germany) has primarily been used for non-exposed transmural resection of challenging subepithelial or epithelial lesions, where conventional methods may be limited. This technique represents an alternative to surgery in selected patients, and its applications are rapidly expanding. In recent years, eFTR has been described as an alternative to surgery for scars aiming to exclude residual tumors after non-curative endoscopic resection. We present a case of a 41-year-old woman with Lynch syndrome (dMLH1) with rectal adenocarcinoma at the age of 20 underwent anterior resection of the rectum and adjuvant chemoradiotherapy. At the age of 39, during endoscopic surveillance, she presented with a suspicious lesion (Paris 0-Is+IIa, NICE2, JNET2B) measuring 16mm in the hepatic angle, and underwent en bloc endoscopic mucosal resection (EMR). Histopathological analysis revealed a low-grade invasive adenocarcinoma with lymphoid stroma with deep invasion of the submucosa and resection margin involvement (vertical R1). After a multidisciplinary team discussion, complementary surgery was proposed but the patient refused, opting for close endoscopic and imaging surveillance. Two subsequent colonoscopies plus computed tomography (CT) scans showed no signs of macro or microscopic residual or recurrent tumor, even after extensive biopsies of the colonic scar. However, a CT scan 20months post-resection showed a de novo 2cm thickening of the parietal wall in the hepatic angle, consistent with the location of the previous endoscopic resection. Suspecting deep parietal tumor recurrence without superficial endoscopic findings, a transmural endoscopic resection using FTRD® of the EMR scar was performed, whose histology revealed no transparietal tumor recurrence.
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Bibliografía
1. Aslanian HR, Sethi A, Bhutani MS, Goodman AJ, Krishnan K, Lichtenstein DR, et al. ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection. VideoGIE 2019;4:343–50. https://doi.org/10.1016/j.vgie.2019.03.010.
2. Gijsbers K, Laclé M, Elias SG, Backes Y, Bosman J, van Berkel A. Full-Thickness Scar Resection After R1 / Rx Excised T1 Colorectal Cancers as an Alternative to Completion Surgery : Official journal of the American College of Gastroenterology | ACG. Am J Gastroenterol 2022;117:647–53. https://doi.org/10.14309/ajg.0000000000001621.
3. Pimentel-Nunes P, Libânio D, Bastiaansen BAJ, Bhandari P, Bisschops R, Bourke MJ, et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022. Endoscopy 2022;54:591–622. https://doi.org/10.1055/a-1811-7025.
4. Zwager LW, Bastiaansen BAJ, Van Der Spek BW, Heine DN, Schreuder RM, Perk LE, et al. Endoscopic full-thickness resection of T1 colorectal cancers: a retrospective analysis from a multicenter Dutch eFTR registry. Endoscopy 2022;54:475–85. https://doi.org/10.1055/a-1637-9051.
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Instrucciones para citar
Temido M, Santos L, Gravito-Soares E, Gravito-Soares M, Amaro P, Cipriano M, et all. Endoscopic transmural resection as an alternative to colorectal surgery after high-risk (non-curative) endoscopic resection . 10552/2024


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Ficha Técnica

Recibido: 19/05/2024

Aceptado: 23/05/2024

Prepublicado: 04/06/2024

Publicado: 24/07/2025

Tiempo de prepublicación: 16 días

Tiempo de edición del artículo: 431 días


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