A 40-mm laterally spreading tumor (LST) on the fold of transverse colon treated by en bloc exfoliative endoscopic mucosal resection (EMR) using an electro-surgical snare (thin type) and ICC200

Abstract

A transverse colon tumor on the colonic fold, with 40 mm in size, was detected in a 58-year-old man who underwent colonoscopy for a positive occult blood test. Biopsy was taken from the tumor and it revealed tubular adenoma, but the possibility of focal cancer existed, considering the size and endoscopic appearance of the tumor. Exfoliative endoscopic mucosal resection (EMR) using a tip of an electro-surgical snare (thin type) and ICC 200 was performed because strip biopsy was associated with a high risk of piecemeal resection due to the size and the location of the tumor. The tumor was successfully resected en bloc by the exfoliative EMR. Histological examination showed a well differentiated adenocarcinoma-in-adenoma. The margin of the specimen was free of tumor along its circumference. Thus, the pathological findings fulfilled the criteria for curative EMR. This procedure seems to be useful for en bloc resection of relatively large mucosal colorectal tumors, even when they are located on the colony fold.