ASGE JGES Advanced ESD | September 2022-Toyonaga_PAEM

Toyonaga_PAEM_Case2

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This document discusses the use of per anal endoscopic myectomy (PAEM) for the treatment of cT1b cancer in the lower rectum. The author discloses a financial relationship with Olympus and Fujifilm. The limitations of colorectal endoscopic submucosal dissection (ESD) are explored, specifically in relation to the pre-operative diagnosis of deep invasion in large protruded tumors. The muscle retracting sign is shown to be an indicator for discontinuing the procedure in the colon. The resectable rate for tumors with the muscle retracting sign is 64.3% in the colon and 80% in the rectum. Histopathological assessments show that the presence of the muscle retracting sign is associated with lower rates of adenoma and mucosal cancer compared to the absence of the sign. The pocket creation method is mentioned as a technical update in endoscopic procedures, with the first case reported in December 2013. The treatment strategy for pT1 (SM) cancer after endoscopic resection is discussed, emphasizing the low risk of metastasis for deep submucosal invasion. The document also mentions the use of PAEM for endoscopic approach to the muscle layer and the efficacy of PAEM in treating rectal submucosal invasive cancer. The pathological specimen of a patient who underwent PAEM revealed T1b grade 1 sprouting adenocarcinoma with submucosal invasion. The document briefly mentions a protocol for a clinical trial of adjuvant chemoradiation for patients with high-risk rectal submucosal invasive cancer after local resection. Finally, the three options for endoscopic procedures mentioned are 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

muscle retracting sign

resectable rate

pocket creation method

pT1 (SM) cancer

rectal submucosal invasive cancer

adjuvant chemoradiation