Intermittent double-layer closure for full-thickness defect after super minimally invasive stepwise resection of early rectal cancer

Endoscopic local resection is increasingly regarded as a feasible alternative to radical surgery for specific early rectal cancer patients, preserving organ function and reducing the incidence of complications [1] [2]. However, the safe closure of large full-thickness defects after local full-thickness resection remains challenging [3]. This report describes a novel solution – the application of super minimally invasive stepwise full-thickness resection combined with an intermittent double-layer closure technique. Stepwise full-thickness resection is a new technique that combines endoscopic submucosal dissection (ESD) with direct full-thickness resection, using the exposed muscular layer after ESD for the first layer of closure; then, the second layer of closure is performed from mucosa to mucosa.