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Endoscopic submucosal dissection successfully resects a large circumferential lesion with concurrent schistosomal colopathyEndoscopic surgery successfully removes large colorectal cancer lesion

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Key Takeaway
Note that ESD can successfully resect large circumferential lesions in patients with concurrent schistosomal colopathy.

This case report describes a single instance of endoscopic submucosal dissection (ESD) used to treat a complex colorectal lesion. The patient presented with a giant circumferential mixed-nodular laterally spreading lesion extending from the anal verge to 8 cm proximally, complicated by concurrent schistosomal colopathy.

The primary outcome was the successful en bloc ESD resection of this extensive lesion. Histopathology confirmed the presence of moderately differentiated adenocarcinoma. The report highlights that ESD can be an effective therapeutic modality for complex cases involving large circumferential lesions near the anal verge in patients with underlying conditions like schistosomal colopathy.

A significant limitation of this evidence is its status as a single case report. It does not provide sufficient data to establish general clinical guidelines or broad efficacy for the procedure across diverse populations. Clinical application should be based on individual patient factors and expert judgment.

How this fits prior evidence

This case report addresses a gap in documented management strategies for complex colorectal lesions involving large circumferential dimensions near the anal verge, particularly when complicated by conditions like schistosomal colopathy. It does not relate to previously covered topics such as AXIN2 mutations, MRI-based radiomics models, indigo carmine detection rates, radiation dermatitis treatments, or fecal microbiota transplantation.

Imagine facing a massive growth in the lower part of your digestive tract. For some patients, these tumors are so large and spread so wide that they are difficult to treat safely. This case highlights how a specific endoscopic technique can manage even very complex cases.

A patient with a giant, spreading lesion near the anal verge underwent an endoscopic submucosal dissection (ESD). This procedure is a way to remove tissue through an endoscope. The team successfully removed the entire large mass in one piece despite its size and the presence of schistosomal colopathy, which is a condition caused by a parasite.

The final tests confirmed that the tissue was moderately differentiated adenocarcinoma, a type of cancer. While this was only one patient, it shows that ESD can be a safe and effective way to treat large, complex tumors in specific cases. Because this was a single case report, it does not set a new rule for everyone, but it offers hope for managing difficult locations.

What this means for you:
Endoscopic surgery successfully removed a large, complex colon tumor even when complicated by a parasite infection.

Common questions

What was the specific treatment used for this large tumor?

The patient underwent an endoscopic submucosal dissection (ESD). This technique allowed doctors to successfully remove the entire giant, spreading lesion in one piece. It is a way to treat complex cases where the tumor is very large or located in difficult areas like near the anal verge.

Was the surgery successful for this patient?

Yes, the procedure was successful. Doctors were able to perform an en bloc resection, which means they removed the entire large lesion at once. Testing later confirmed that the tissue removed was a type of cancer called moderately differentiated adenocarcinoma.

How did the patient's other condition affect the treatment?

The patient also had schistosomal colopathy, which is a condition caused by a parasite. The successful surgery showed that this endoscopic method can be safe and effective even in complex cases involving large lesions and concurrent conditions like this one.

Study Details

Study typeGuideline
EvidenceLevel 5
PublishedAug 2026
View Original Abstract ↓
Colorectal adenomatous polyps are well-established as the principal precancerous lesions underlying the adenoma-carcinoma sequence in colorectal carcinogenesis. The World Endoscopy Organization (WEO) consensus guidelines strongly advocate en bloc resection over piecemeal resection for laterally spreading lesions measuring >20 mm in diameter, given their elevated risk of superficial submucosal invasion. Nevertheless, achieving complete en bloc resection via endoscopic submucosal dissection (ESD) for circumferential lesions situated immediately adjacent to the anal verge and exceeding 10 cm in maximum dimension represents a formidable technical challenge. Herein, we report the successful en bloc ESD resection of a giant circumferential mixed-nodular laterally spreading lesion extending from the anal verge to 8 cm proximally, with postoperative histopathology confirming moderately differentiated adenocarcinoma (Figure 5). The patient presented with concomitant schistosomal colopathy, which further compounded the procedural complexity of ESD. Notwithstanding these challenges, meticulous perioperative assessment, refined surgical technique, and comprehensive postoperative management collectively demonstrate that ESD remains a safe and effective therapeutic modality for appropriately selected patients.
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