[Endoscopic resection of a scarred rectal adenoma using EndoRotor]

Benign colorectal neoplasia are commonly resected using snare resection or endoscopic submucosal dissection (ESD). These methods are safe, but just the piecemeal resection in flat adenomas greater than 20 mm harbor a relevant risk of recurrence. Interventional endoscopic therapy of recurrent lesions can be challenging, even in expert hands due to a high risk of complications. While smaller, scarred recurrent adenomas less than 20 mm are suitable for endoscopic full-thickness resection, hitherto larger ones have had to be removed with more laborious, time-consuming and costly endoscopic methods, or had to undergo surgery.

The EndoRotor is a novel non-diathermic resection system for benign neoplasia in the gastrointestinal tract. The tissue is aspirated into an opening at the tip of a flexible resection catheter, dissected by means of a rotating blade on the inside of the catheter and finally transported into a tissue trap.

We present the case of a 79-year-old female patient with a large recurrent adenoma of a lateral-spreading tumor granular type in the rectum. Whereas a part of the adenoma could be resected with ESD, the scarred parts were not amenable to traditional endoscopic methods. By using EndoRotor, the scarred adenoma could be resected completely and without any complication.

Scarred adenomas pose a challenge for interventional endoscopy. In this case study, EndoRotor proved to be a safe and viable method and a new resection option for complicated scarred rectal adenomas.