Endoscopic synchronous injection and submucosal dissection for large granular mixed nodular laterally spreading tumor in the rectum

Sep 30, 2026

A large granular mixed nodular laterally spreading tumor (LST-G-M) in the rectum was treated using endoscopic synchronous injection and submucosal dissection (ESISD). An 81-year-old male underwent ESISD for a flat elevated lesion occupying nearly 80% of the rectal circumference, about 10 cm from the anal verge. ESISD integrated injection and dissection in one procedure, achieving en bloc resection in 116 minutes with an estimated blood loss of 10 mL. Pathology showed tubulovillous adenoma with predominantly low-grade dysplasia and focal high-grade dysplasia, without needing injection needles or specialized agents.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Case and lesion characteristics

ESISD procedure outcomes

Pathology results

ESISD vs conventional ESD

Article published online: 2026-01-08 Endoscopic synchronous injection and submucosal dissection for large granular mixed nodular laterally spreading tumor in the rectum ▶Fig. 1 Patient underwent endoscopic mucosal dissection (ESD) and postoperative pathological result. a Colonoscopy revealed a nearly 80% circumferential flat elevated lesion located approximately 10cm proximal to the anal verge and extending to the dentate line, consistent with LST-G-M (laterally spreading tumor, granular mixed subtype) . b Post-ESISD surgical wound bed. c Gross specimen dimensions: 11 .5cm×11 .5cm. d Histopathological examination of the ESD specimen confirmed tubulovillous adenoma with predominantly low-grade dysplasia and focal areas of high-grade dysplasia (hematoxylin and eosin stain, original magnification×10) . An 81-year-old male patient was admitted for endoscopic submucosal dissection (ESD) of a granular mixed nodular laterally spreading tumor (LST-G-M; ▶ Fig.1a) . The lesion presented as a flat, elevated mass occupying nearly 80% of the rectal circumference, located approximately 10cm from the anal verge and extending to the dentate line. Given the large lesion size and the rectum ’s rich vascular supply, we innovatively employed endoscopic synchronous injection and submucosal dissection (ESISD) to minimize bleeding and improve dissection efficiency. The procedure was completed in 116 minutes, with an estimated blood loss of 10mL, yielding an en bloc resection specimen measuring 11 .5cm× 11.5cm. Postoperative pathology revealed tubulovillous adenoma with low- grade dysplasia in most areas and focal high-grade dysplasia ( ▶ Fig.1b–d) . A comparable case using conventional ESD (CESD) served as the control ( ▶Video 1) . ESD provides a minimally invasive approach for the curative treatment of benign, precancerous, and early neoplastic lesions in the gastrointestinal tract [1] . In CESD, submucosal injection creates a“fluid cushion” that separates the mucosal layer from the muscularis propria, thereby reducing perforation risks [2] . However, rapid absorption of normal saline often requires repeated injections, which can prolong the procedure time. Despite the growing use of novel submucosal injection agents, their cost-effectiveness, accessibility, and the advancement of innovative injection techniques remain critical considerations. Video 1 Endoscopic submucosal injection synchronous dissection without prior needle-assisted injection for the rectal laterally spreading tumor (LST) . By contrast, ESISD eliminates the need for injection needles or specialized submucosal agents by integrating injection and dissection into a single procedure ( ▶ Fig.2) . This approach reduces procedural costs, shortens the operation time, and enhances hemostasis during dissection. Additionally, it minimizes electrosurgical carbonization of the knife, preserving its cutting efficacy. The simplicity and broad applicability of ESISD can enhance traditional ESD workflows, warranting further validation across diverse patient populations. Endoscopy_UCTN_Code_TTT_ 1AQ_ 2AD_ 3AD Contributors ʼ Statement Xiao-Bo Liu: Conceptualization, Data curation, Formal analysis, Funding acquisition, Writing – original draft, Writing – review & editing. Hai-Tao Shen: Data curation, Formal analysis, Investigation, Writing – original draft. Ruo-Jin Yu: Data curation, Software, Writing – original draft. Tie-Yan Wang: Conceptualization, Methodology, Resources, Visualization. Yuan-Jun Gao: Conceptualization, Project administration, Supervision, Writing – review & editing. Liu Xiao-Bo et al. Endoscopic synchronous injection… Endoscopy 2026; 58: E3–E4 | © 2026. The Author(s) . E3 ▶Fig.2 Comparative schematic illustrations of two distinct endoscopic resection techniques: endoscopic submucosal dissection (ESD) and endoscopic submucosal injection synchronous dissection (ESISD) . Acknowledgement | We sincerely appreciate the patient for placing their trust in our c

FAQs

What does ESISD change compared with conventional ESD?

ESISD integrates injection and submucosal dissection into a single procedure, eliminating injection needles or specialized submucosal agents used in conventional ESD.

What were the reported operative time and blood loss for the ESISD case?

The procedure was completed in 116 minutes with an estimated blood loss of 10 mL.

What did postoperative pathology show after ESISD?

The resection specimen showed tubulovillous adenoma with predominantly low-grade dysplasia and focal areas of high-grade dysplasia.

Sep 30, 2026

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