Abstract
Objectives : A complete resection of the lesion is the most important factor to determine the efficacy of the endoscopic therapy. This method was attempted to make up for weak point of piecemeal resection such as recurrence of lesion. A management of a rectal lesion should be more careful than that of a colon, because complications of rectal surgery are more frequent and risky. To avoid over-treatment, excision biopsy of rectal lesion is important, and the specimen should be good information to decide additional surgical treatment.
Methods : Indication of this method is only in the rectum. Because the wall of rectum is thicker than that of colon, and there is less complication of perforation. Initially, saline with epinephrine solution was injected into submucosal layer around the lesion to lift it off the muscular layer. A needle knife was used for cutting around the lesion. Then insulation-tipped electro surgical (IT) knife was used for exfoliating the lesion from submucosal layer.
Results : 4 patients were performed with this method. The lesions were completely resected with one piece. The mean diameter of resected tumors was 35 mm. All the lesions were consisted carcinoma with adenoma component. Immediate minor bleeding without transfusion was recognized in 2 patients, and was controlled with hemoclip. There were no perforations.
Case 1 : 59 y/o F 45 mm, depth m, ly (－) , v (－) .
Case 2 : 63 y/o M 20 mm, depth sm2, ly (＋) , v (－) , addition surgical resection.
Case 3 : 70 y/o M 40 mm, depth sm2, ly (－) , v (－) .
Case 4 : 60 y/o M 30 mm, depth m, ly (－) , v (－) .
Conclusion : This new method is able to remove the lesion with large one piece without serious complication. These specimens gave us good information for management of rectal tumor.
