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Endosc Int Open 2016; 04(01): E93-E95
DOI: 10.1055/s-0041-107902
Case report
© Georg Thieme Verlag KG Stuttgart · New York

A novel retrieval technique for large colorectal tumors resected by endoscopic submucosal dissection: tumor extraction by defecation

Daiki Nemoto
1   Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima 969-3492 Japan
,
Yoshikazu Hayashi
2   Department of Gastroenterology, Jichi Medical University, Tochigi 329-0498 Japan
,
Kenichi Utano
1   Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima 969-3492 Japan
,
Noriyuki Isohata
1   Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima 969-3492 Japan
,
Shungo Endo
1   Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima 969-3492 Japan
,
Alan K Lefor
3   Department of Surgery, Jichi Medical University, Tochigi 329-0498 Japan
,
Hironori Yamamoto
2   Department of Gastroenterology, Jichi Medical University, Tochigi 329-0498 Japan
,
Kazutomo Togashi
1   Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima 969-3492 Japan
› Author Affiliations
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Publication History

Publication Date:
08 January 2016 (online)

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Background and study aims: Endoscopic submucosal dissection (ESD) has been developed to facilitate en bloc resection of large lesions. However, it is laborious to retrieve the large colorectal specimens. We propose a novel retrieval technique using a Valsalva maneuver, known as Tumor Extraction by Defecation (TED).

Case series: A total of nine lesions (median size 88 mm, maximum 225 mm; proximal colon three, rectum six) that could not be easily retrieved using net forceps were subsequently removed by TED. The rectum was filled with water through the colonoscope. The patient then strained to evacuate the specimen, facilitated by an almost straight anorectal angle. All specimens were retrieved without fragmentation, within minutes. Histology was assessed appropriately, including an adenoma in two and mucosal cancer in seven. All cut margins were verified to be negative. No adverse events occurred.

Conclusions: TED is a promising technique for retrieving large colorectal specimens after ESD.

 

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