Okasha HH, Wahba M, Fontagnier E, Abdellatef A, Haggag H, AbouElenin S. Hidden local recurrence of colorectal adenocarcinoma diagnosed by endoscopic ultrasound: A case series. World J Gastrointest Endosc 2022; 14(8): 502-507 [PMID: 36158634 DOI: 10.4253/wjge.v14.i8.502]
Corresponding Author of This Article
Abeer Abdellatef, MD, Lecturer, Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, 1 Gamaa Street, Cairo 11451, Egypt. beero4a@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hussein Hassan Okasha, Mahmoud Wahba, Abeer Abdellatef, Hani Haggag, Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
Eva Fontagnier, Department of Internal Medicine and Gastroenterology, Tawam Hospital, Al-Ain 00000, United Arab Emirates
Sameh AbouElenin, Department of Internal Medicine and Gastroenterology, Military Medical Academy, Cairo 11451, Egypt
Author contributions: Wahba M and Abdellatif AA were involved equally in writing the manuscript; Fontagnier E and Hagag H were involved equally in collecting the data; Elenin SA read and revised the manuscript; Okasha HH revised and approved the final manuscript; all authors have read and approved the final manuscript.
Informed consent statement: The study was approved by our institution’s Research Ethical Committee, and all patients gave their informed written consent before inclusion in the study, according to the ethical guidelines of the 1975 Declaration of Helsinki.
Conflict-of-interest statement: All authors declare no competing interests for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abeer Abdellatef, MD, Lecturer, Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, 1 Gamaa Street, Cairo 11451, Egypt. beero4a@yahoo.com
Received: January 18, 2022 Peer-review started: January 18, 2022 First decision: April 17, 2022 Revised: April 29, 2022 Accepted: July 16, 2022 Article in press: July 16, 2022 Published online: August 16, 2022
Abstract
BACKGROUND
Almost half of the patients with colorectal cancer (CRC) will experience local-regional recurrence after standard surgical excision. Many local recurrences of colorectal cancer (LRCC) do not grow intraluminally, and some may be covered by a normal mucosa so that they could be missed by colonoscopy. Early detection is crucial as it offers a chance to achieve curative reoperation. Endoscopic ultrasound (EUS) is mainly used in CRC staging combined with cross-section imaging study. EUS can provide an accurate assessment of sub-mucosal lesions by demarcating the originating wall layer and evaluating its echostructure. EUS fine-needle aspiration (FNA) provides the required tissue examination and confirms the diagnosis.
CASE SUMMARY
We report a series of five cases referred to surveillance for LRCC with negative colonoscopy and/or negative endoscopic biopsies. EUS-FNA confirmed LRCC implanted deep into the third and fourth wall layer with normal first and second layer.
CONCLUSION
Assessment for LCRR is still problematic and may be very tricky. EUS and EUS-FNA may be useful tools to exclude local recurrence.
Core Tip: The local recurrence of colorectal adenocarcinoma that has been implanted deeply in the submucosal layers is usually missed by colonoscopy, despite that some cases show submucosal elevation. Endoscopic biopsies often give negative results, so endoscopic ultrasound fine-needle aspiration can be used to confirm the diagnosis and give patients a better chance for proper management.
