ArticleVideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy2026
Saline-tunneling endoscopic submucosal dissection for residual rectal lesion at anastomotic staple line.
Article in VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and Aims: Endoscopic submucosal dissection (ESD) in surgically altered colorectal anatomy is challenging because of postsurgical fibrosis and the presence of staples. We report a case of a combined saline immersion and tunneling ESD ("saline-tunneling" ESD) for a lesion at a stapled rectal anastomosis. Methods: A 67-year-old man with T3N1M0 rectal cancer underwent neoadjuvant chemoradiotherapy in 2019 followed by proctosigmoidectomy in 2020. A postoperative colonoscopy detected a residual lesion, but the patient was lost to follow-up until 2023. At that time, Results: En bloc resection of the lesion was achieved. Histopathology confirmed a tubulovillous adenoma with high-grade dysplasia and negative margins. Conclusions: This case demonstrates the successful integration of submucosal tunneling and saline immersion techniques at a stapled rectal anastomosis. The novel saline-tunneling ESD approach may offer a safe, effective alternative to repeat surgery for fibrotic, anatomically constrained colorectal lesions.
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