title: A novel retrieval technique for large colorectal tumors resected by endoscopic submucosal dissection: tumor extraction by defecation.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
authors.affiliation: Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima 969-3492 Japan.
authors.forename: Daiki
authors.initials: D
authors.lastname: Nemoto
authors.affiliation: Department of Gastroenterology, Jichi Medical University, Tochigi 329-0498 Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima 969-3492 Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Utano
authors.affiliation: Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima 969-3492 Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Isohata
authors.affiliation: Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima 969-3492 Japan.
authors.forename: Shungo
authors.initials: S
authors.lastname: Endo
authors.affiliation: Department of Surgery, Jichi Medical University, Tochigi 329-0498 Japan.
authors.forename: Alan K
authors.initials: AK
authors.lastname: Lefor
authors.affiliation: Department of Gastroenterology, Jichi Medical University, Tochigi 329-0498 Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima 969-3492 Japan.
authors.forename: Kazutomo
authors.initials: K
authors.lastname: Togashi