ASGE JGES Advanced ESD (On-Demand) | September 2022 OLESDSEPT22ADV-Toyonaga_PAEM

Toyonaga_PAEM_Case2

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This document highlights the use of per anal endoscopic myectomy (PAEM) as a treatment option for cT1b cancer in the lower rectum. The author discloses a financial relationship with Olympus and Fujifilm. The document discusses the limitations of colorectal endoscopic submucosal dissection (ESD) and the importance of pre-operative diagnosis of deep invasion in large protruded tumors. It also presents data on the discontinuation of the procedure in the colon based on the presence or absence of the muscle retracting sign. The resectable rate is higher in the rectum compared to the colon. Histopathological assessment shows varying rates of adenoma and cancer based on the MR sign. The pocket-creation method is described as a technical update for PAEM. Treatment strategies for pT1 (SM) cancer after endoscopic resection are presented, focusing on the low risk of metastasis in cases of deep submucosal invasion. The document mentions a follow-up study with no local recurrence or metastasis after 5 years. PAEM is described as an endoscopic approach to the muscle layer, and its use is supported by studies. The document concludes with information about a confirmatory trial of adjuvant chemoradiation for high-risk rectal submucosal invasive cancer after local resection. The inclusion criteria for the trial are outlined, including the types of local resections performed. Finally, three treatment options for colorectal ESD are presented: the conventional flap method, traction device assisted ESD, and the pocket creation method (PAEM).

Keywords

per anal endoscopic myectomy

cT1b cancer

lower rectum

colorectal endoscopic submucosal dissection

pre-operative diagnosis

muscle retracting sign

rectum

colon

pocket-creation method

adjuvant chemoradiation