Endoscopic submucosal dissection combined with endoscopic hand suturing for a laterally spreading tumor spanning the anastomosis after radical resection of a rectal carcinoma

Precancerous lesions or early cancers located at the anastomosis after radical resection of a rectal carcinoma are relatively rare [1] [2]. Recently, several studies have suggested that endoscopic submucosal dissection (ESD) is a favorable treatment for such lesions [3] [4] [5]; however, because of severe adhesion in the submucosa of lesions that are located at the anastomosis, partial excision of the circular muscle layer may be required to prevent positive margins. We report a novel measure combining endoscopic hand suturing (EHS) with ESD, to close the postoperative defect following this, which is expected to be an ideal endoscopic method for precancerous lesions or early cancers that span the anastomosis after radical resection of a rectal carcinoma.