Chronic diarrhea improvement after ESD of rectal villous tumor

Abstract

A 70-year-old man complained of persistent diarrhea for 6 months, and a colonoscopy in a previous hospital revealed a large rectal tumor. He was referred to our hospital for tumor resection. Our colonoscopy revealed a villous tumor (55-mm diameter) of flat elevated type in the rectum accompanied by mucus secretion, and magnifying endoscopy revealed a Kudo's type IV_B and IVv pit pattern. Thus, the tumor was diagnosed as carcinoma in tubulovillous adenoma, and endoscopic submucosal dissection (ESD) was performed. A pathological examination showed high grade tubulovillous adenoma. The diarrhea immediately disappeared after ESD. Mucus discharge in a large villous tumor may cause persistent diarrhea and electrolyte abnormalities. Previous reports have shown surgical resections of large rectal villous tumors; nowadays, ESD can be performed after a careful endoscopic examination.