First reported case of per anal endoscopic myectomy (PAEM): A novel endoscopic technique for resection of lesions with severe fibrosis in the rectum

• Published in: Endoscopy International Open Vol. 5; no. 3; pp. E146 - E150
• Main Authors: Rahni, David Ozzie, Toyonaga, Takashi, Ohara, Yoshiko, Lombardo, Francesco, Baba, Shinichi, Takihara, Hiroshi, Tanaka, Shinwa, Kawara, Fumiaki, Azuma, Takeshi
• Format: Journal Article
• Language: English
• Published: Stuttgart · New York Georg Thieme Verlag KG 01.03.2017
• Subjects: Case report
• ISSN: 2364-3722; 2196-9736
• DOI: 10.1055/s-0042-122965

Background and study aims  A 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.