Hybrid endoscopic submucosal dissection and endoscopic full-thickness resection for R0 resection of T1 colonic adenocarcinoma

Abstract

Background and Aims: Malignant colorectal polyps limited to superficial submucosa can undergo endoscopic resection as a curative strategy. Endoscopic full-thickness resection (EFTR) allows en bloc resection of malignant polyps; however, the technique is challenging in lesions with submucosal invasion or those >20 mm in size. Methods: This original article and accompanying video reviews the technique for hybrid endoscopic submucosal dissection (ESD) and EFTR to allow R0 resection of T1 colonic adenocarcinoma. Results: In the case example, ESD was performed to make a 35-mm lesion pliable. This step allowed the lesion to be pulled into the cap and complete en bloc resection using the full-thickness resection device. Conclusions: The case highlights that hybrid ESD-EFTR technique is feasible and allows for en bloc removal of superficially invasive submucosal colon adenocarcinoma with lesions >20 mm in size. Initial mucosal incision and partial submucosal dissection can make the lesions with underlying submucosal invasion pliable and hence amenable to full-thickness resection using a full-thickness resection device.