Management of local recurrence after endoscopic resection of neoplastic colonic polyps

Figure 1 Endoscopic submucosal dissection of recurrent lesion in the cecum. A: A Local recurrence (laterally spreading tumor, granular type) was identified in the cecum 18 mo after piecemeal endoscopic mucosal resection; B: The Japan Narrow-band imaging Expert Team classification was type 2B[19]; C: Kudo’s pit pattern was V_I[20]. The laterally spreading tumor was diagnosed as an intramucosal lesion and ESD performed; D, E: Although there was severe fibrosis in the submucosal layer, en bloc resection was achieved; F: The pathological diagnosis was adenocarcinoma arising from a sessile serrated adenoma/polyp, type 0-IIa, 16 × 15 mm, pTis, pHM0, pVM0; ER0, Cur EA; pap > tub1, ly0, v0.

Figure 2 Underwater endoscopic mucosal resection of a recurrent lesion in the cecum. A: A local recurrence was identified in the cecum 12 mo after en bloc endoscopic mucosal resection; B: Magnified endoscopy with narrow band imaging revealed Japan Narrow-band imaging Expert Team classification type 2A; C: Underwater endoscopic mucosal resection was performed after marking; D: Complete resection was achieved. E, F: The pathological diagnosis was low grade adenoma.