Abstract
A 54-year-old man who has no subjective symptoms was referred to our hospital for further examination following a positive fecal occult blood test. Colonoscopy showed an elevated lesion of 35 mm diameter in the rectum. Pathological diagnosis of the biopsy specimen was carcinoma in adenoma. Since preoperative diagnosis was intramucosal carcinoma, endoscopic submucosal dissection (ESD) was attempted. However, ESD was abandoned owing to sever submucosal fibrosis. He underwent a laparoscopic colectomy afterward. The histopathological diagnosis was adenocarcinoma,pTis, ly0, v0, pN0 (0/13). There are no criteria for abandonment of ESD in case of severe submucosal fibrosis, but it should be abandoned if the submucosal layer is not identified including the case of muscle traction. In order to perform safety ESD, it is necessary to have the ability to judge abandonment of endoscopic treatment depending on the situation by understanding your own skill and the technical difficulty according to location.
