First reported case of per anal endoscopic myectomy (PAEM): A novel endoscopic technique for resection of lesions with severe fibrosis in the rectum.
Background and study aimsA 54-year-old man was diagnosed with a rectal tumor extending through the submucosal layer. The patient refused surgery and therefore endoscopic submucosal dissection (ESD) was pursued. The lesion exhibited the muscle retraction sign.After dissecting circumferentially around the fibrotic area by double tunneling method, a myotomy was performed through the internal circular muscle layer, creating a plane of dissection between the internal circular muscle layer and the external longitudinal muscle layer, and a myectomy was completed. The pathologic specimen verified T1b grade 1 sprouting adenocarcinoma with 4350 µm invasion into the submucosa with negative resection margins.
Brown University/Rhode Island Hospital, Rhode Island Hospital, Providence, United States.
David Ozzie
DO
Rahni
Department of Endoscopy, Kobe University Hospital, Kobe, Japan; Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
Takashi
T
Toyonaga
Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
Yoshiko
Y
Ohara
Emergency Endoscopy Unit, Borgo Trento Hospital, Verona, Italy.
Francesco
F
Lombardo
Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
Shinichi
S
Baba
Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
Hiroshi
H
Takihara
Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
Shinwa
S
Tanaka
Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
Fumiaki
F
Kawara
Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
Takeshi
T
Azuma