Combined Endoscopic Submucosal Dissection and Transanal Minimally Invasive Surgery for Rectal Laterally Spreading Tumor after Prior Transanal Resection: A Case Report

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INTRODUCTION: Endoscopic submucosal dissection (ESD) is an effective procedure for resecting noninvasive colorectal neoplasms. However, submucosal fibrosis affects the technical difficulty of ESD. We experienced a combined ESD and transanal minimally invasive surgery (TAMIS) for a rectal neoplasm with submucosal fibrosis.

CASE PRESENTATION: We report our experience with a 75-year-old woman who had a rectal laterally spreading tumor with scarring from a prior transanal resection. She underwent combined ESD and TAMIS to overcome the procedural difficulty of ESD for submucosal fibrosis. The portion of the bowel without scarring was dissected using ESD, while the portion with scarring was dissected using TAMIS. A successful en bloc resection of the tumor was achieved, and there was no recurrence.

CONCLUSIONS: Based on the findings from this case, the combination of ESD and TAMIS may be particularly effective under conditions such as rectal neoplasms with submucosal fibrosis.