Between the third and second space: an endoscopic submucosal dissection (ESD) with mesorectal space exposure of a recurrent circumferential lesion of the rectum

Text A 70-year-old man underwent colonoscopy in 2020 for diarrhoea. The colonoscopy detected a semi-circumferential granular rectal polyp at the lower rectum that was treated with trans-anal endoscopic microsurgery (TEM) at another Institution, after multiple endoscopic resection attempts. Endoscopic surveillance in 2023 revealed a locally recurrent circumferential adenoma extending beyond the dentate line and involving multiple traction areas due to the previous surgery. Patient was referred to our Institution to evaluate an endoscopic treatment and avoid Miles' surgery. ESD with partial full-thickness resection was proposed. Circumferential ESD with mesorectal exposure was performed obtaining an en bloc resection (R0). Afterwards, the patient showed symptoms due to stenosis, which was treated with mechanical dilation in outpatient settings.