ESD treatment of early cecal cancer

Hotta_headshotKinichi Hotta, MD, from the Division of Endoscopy, Shizuoka Cancer Center, in Shizuoka, Japan describes this VideoGIE case “Early cecal cancer adjacent to the appendiceal orifice successfully treated by endoscopic submucosal dissection.”

The cecal tumor adjacent to the appendiceal orifice (CTAO) is considered one of the most difficult lesions to be treated by endoscopic resection. This case was an early cecal T1 cancer which had been successfully treated by endoscopic submucosal dissection (ESD) in en-bloc and R0 resection. Tips of ESD technique unique to this case was that first step mucosal incision was made by only one third at the appendiceal orifice side and submucosal dissection was subsequently done before total circumferential incision. Pathologically this case was diagnosed as a submucosal invasive cancer (invasion depth 240μm from the muscularis mucosae), but there was no other risk factor of metastases. Therefore, this case was considered as curatively treated by ESD.

Figure 1. A, Colonoscopic view of flat elevated lesion with slight depression adjacent to the appendiceal orifice. B, Submucosal injection of sodium hyaluronate solution and circumferential incision at the side of the appendiceal orifice. C, Complete en bloc resection of the lesion without intraoperative or postoperative adverse events.

ESD is very useful for the lesion which is difficult to be treated by conventional endoscopic resection method.

This lesion was diagnosed as a laterally spreading tumor, non-granular type. Moreover, preoperative diagnosis was slightly submucosal invasive cancer by magnified chromoendoscopy.

Treatment strategy of CTAOs should be considered according to location, size, and estimated depth. Precutting EMR is one of the options which was reported in a previous VideoGIE from us (Gastrointest Endosc 2015;82:750).

Find more VideoGIE cases online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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