Endoscopic Intermuscular Dissection: A New Frontier in the Treatment of Rectal Adenocarcinoma

Abstract Text A 57-year-old female presented with a 25-mm sessile distal rectal pseudodepressed lesion (Paris 0-IIa+0-IIc, surface pattern JNET2B, NICE2 -periphery- and NICE 3-center). EUS raised suspicion of muscularis propria involvement. A multidisciplinary team recommended endoscopic resection, which was performed after patient agreement. Submucosal injection, pre-cut, and tunneling were followed by intermuscular dissection of the center of the lesion due to suspected muscularis propria invasion.The defect was closed completely. The patient had no complications and was discharged 24h post-procedure. Histopathology confirmed R0 resection of an adenocarcinoma pT2, with no lymphovascular or perineural invasion. This case highlights R0 endoscopic intermuscular dissection as a viable option for cases of initial T2 of the distal rectum [1] [2] [3] [4].

Video http://data.process.y-congress.com/ScientificProcess/Data//106/570/1428/a13fc613-36dd-4d7c-9fe1-17aae6965934/Uploads/16849_final_video%20-%20intermuscular%20dissection.mp4

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Binda C., Secco M., Tuccillo L., Coluccio C., Liverani E., Jung C.F.M., Fabbri C., Gibiino G.. Early Rectal Cancer and Local Excision: A Narrative Review. J. Clin. Med 2024; 13: 2292
• 2 Hao Dang, BSc, James C. H. Hardwick, MD, PhD, Jurjen J. Boonstra, MD, PhD Endoscopic intermuscular dissection with intermuscular tunneling for local resection of rectal cancer with deep submucosal invasion. VIDEOGIE. 2022; 7 (No. 8) doi:10.1016/j.vgie.2022.02.012.
• 3 Sekra A, Tan T.. Endoscopic intermuscular dissection for locally advanced rectal cancer: A case report. World J Surg Proced 2023; 13 (3): 22-28
• 4 Moons LMG, Bastiaansen BAJ, Richir MC, Hazen WL, Tuynman J, Elias SG, Schrauwen RWM, Vleggaar FP, Dekker E, Bos P, Fariña Sarasqueta A, Lacle M, Hompes R, Didden P.. Endoscopic intermuscular dissection for deep submucosal invasive cancer in the rectum: a new endoscopic approach. Endoscopy 2022; 54 (10): 993-998 Epub 2022 Jan 2435073588

Publication History

Article published online:
27 March 2025