PAEM COMBINED WITH ENDOSCOPIC SUBMUCOSAL HYDRO-DISSECTION AS A RESCUE THERAPY OF RECTAL FIBROTIC ADENOMA IN ILEORRECTAL ANASTOMOSIS. A CASE REPORT

Background:

Subtotal colectomy with ileorrectal anastomosis (IRA) is currently the most common surgical option in young patients with familiar adenomatous polyposis (FAP). However, this surgery does not stave off suffering the appearance of lesions in the rectal remnant. In these cases, the endoscopic submucosal dissection might be a feasible option. However, drawbacks such as: extreme fibrosis and difficult manoeuvrability in rectal remnant, become this technique rather challenging. We planned to carried out a PAEM combined by ESD with pocket creation method with the purpose of overcoming these handicaps.

Case report:

Following this approach, we successfully achieved en-bloq resection of a 30 mm recurrent adenoma located in rectal remnant of a 42 year-old woman with FAP. We performed a PCM to reach the anastomotic area in which we carried out a PAEM removing the suture staples. Thereafter we continued the ESD as usual to finally enrich the en bloc resection. After the resection, we showed the anastomosis opended which closed by second-intention with no adverse events. Two months follow up endoscopy showed no residual adenomatous tissue. All steps of the procedure were performed using Erbejet Hybrid-Knife type T (ERBE).

Conclusion:

In summary, PAEM combined by endoscopic submucosal dissection using pocket creation method allowed a safe and effective dissection, achieving en-bloc resection of this challenging polyp.