Endoscopic intermuscular dissection: insights from China on minimally invasive treatment for early rectal cancer

Endoscopic intermuscular dissection: insights from China on minimally invasive treatment for early rectal cancerA 73-year-old woman presented with a history of increased bowel movements and intermittent rectal bleeding for 1 month.A colonoscopy revealed tumors in the rectum, which were confirmed through biopsy as adenoma and intraepithelial neoplasia.Staging with computed tomography and magnetic resonance imaging indicated T2N0-1aM0 disease.Endoscopic intermuscular dissection (EID) was subsequently performed ( Video 1).The EID procedure began with lesion identification using white-light imaging and chromoendoscopy ( Fig. 1), followed by circumferential electrosurgical marking ( Fig. 2).A sodium hyaluronate solution mixed with indigo carmine was injected around the lesion.A mucosal incision exposed the submucosal layer, and any superficial bleeding was managed as necessary.Submucosal dissection deepened to the muscularis propria layer, transitioning to intermuscular dissection between the inner circular and outer longitudinal muscular layers ( Fig. 3).The lesion was completely re-Video 1 Endoscopic intermuscular dissection is performed for an early rectal cancer, allowing the preservation of the external longitudinal muscle layer. Fig. 1 Imaging studies on the tumor.a White-light image.b Blue-light image. Fig. 2 Marking the boundaries of the tumor. Fig. 3 Intermuscular dissection: inner circular muscle excision, outer longitudinal muscle preservation. Fig. 4 Complete resection of the lesion and complete closure of the wound.