Asayama N, Ikehara H, Yano H, Saito Y. Endoscopic submucosal dissection of multiple flat adenomas in the radiated rectum. World J Gastrointest Endosc 2013; 5(3): 128-131 [PMID: 23515559 DOI: 10.4253/wjge.v5.i3.128]
Corresponding Author of This Article
Naoki Asayama, MD, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-0855, Japan. a-s-ayama@hotmail.co.jp
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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Naoki Asayama, Hisatomo Ikehara, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-0855, Japan
Hideaki Yano, Yukio Saito, Department of Surgery, National Center for Global Health and Medicine, Tokyo 162-0855, Japan
Author contributions: Asayama N performed endoscopy and wrote the manuscript; Ikehara H performed endoscopic submucosal dissection of multiple flat adenomas in the radiated rectum and reviewed the literature; Yano H and Saito Y performed the operation for rectal cancer and revised the manuscript.
Correspondence to: Naoki Asayama, MD, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-0855, Japan. a-s-ayama@hotmail.co.jp
Telephone: +81-3-32027181 Fax: +81-3-32071038
Received: May 12, 2012 Revised: September 17, 2012 Accepted: December 22, 2012 Published online: March 16, 2013
Abstract
We report a case of multiple flat adenomas and cancer of the rectum that occurred 15 years after pelvic irradiation following surgery for uterine cancer. Adenoma borders were diagnosed accurately by magnifying chromoendoscopy, leading to their adequate excision using endoscopic submucosal dissection. This enabled minimal dissection of the irradiated pelvis that would have otherwise been difficult. Furthermore, our approach probably helped minimize loss of bowel function, thereby preserving the patient’s quality of life as much as possible. Pathology of the resected specimens revealed thickened walls of the submucosal layer vessels, indicating chronic radiation proctitis. Pelvic irradiation of the bowel carries a high risk of causing flat adenomas and cancer. Close and long-term surveillance may be useful in such cases, using not only conventional colonoscopy but also chromoendoscopy with indigo carmine dye spray and magnifying endoscopy.
