Abstract
In the current era of screening colonoscopy and increasing incidence of early rectal cancer, interventional endoscopy moves toward resections in deeper planes than the submucosal layer. Several reports support the use of endoscopic intermuscular dissection (EID) instead of endoscopic submucosal dissection (ESD) for the removal of deeply invasive rectal submucosal cancers. The resection plane into the intermuscular space, the space between the longitudinal (external) and circular (internal) muscle layer, allows radical removal of rectal invasive submucosal cancers. Furthermore, the technique offers the potential for dissection of scarred and severe fibrotic lesions in the rectum by cutting deeper and performing a partial myectomy avoiding the narrow submucosal space. We present 23 cases of EIDs both for deeply invasive rectal cancers and benign rectal lesions. This is the first report in the literature of EID resections for malignant and benign disease, including cases of severely fibrotic rectal lesions.
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The study was approved by the Hospitals Ethics Committee (General Hospital of Nikaia—Piraeus Ethics Committee, Athens, Greece, 16 November 2020) and was performed in accordance with the ethical standards of the declaration of Helsinki.
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Video 1. Endoscopic intermuscular dissection (EID) of a deeply infiltrative rectal adenocarcinoma into the muscle layer (pT2) closely to dentate line. R0 resection achieved by EID; specimen size 65 × 60 mm. Supplementary file1 (MOV 276113 KB)
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Tribonias, G., Komeda, Y., Leontidis, N. et al. Endoscopic intermuscular dissection (EID) for removing early rectal cancers and benign fibrotic rectal lesions. Tech Coloproctol 27, 1393–1400 (2023). https://doi.org/10.1007/s10151-023-02862-7
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DOI: https://doi.org/10.1007/s10151-023-02862-7