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Saline-preserving enema: an effective method for preoperative preparation of endoscopic submucosal dissection in a patient with rectal disuse atrophy

Published:September 21, 2022DOI:https://doi.org/10.1016/j.gie.2022.09.006
      A 58-year-old man was referred to our hospital for reversion of his colon. He had undergone colectomy of sigmoid colon cancer and creation of a colostomy 2 years earlier, followed by repeated chemotherapies. Colonoscopy detected a 4 × 3 cm laterally spreading tumor 2.5 cm from the anus (A). The rectum had mild stenosis, diffuse hyperemia, and spontaneous bleeding, consistent with rectal disuse atrophy. To recover bowel function, we prescribed 2 weeks of saline-preserving enema. An anal tube 5 mm in diameter and 10 cm in length was inserted into the rectum, and 50 to 100 mL saline was injected through the tube twice a day. A total of 10 to 20 minutes was needed each time. Colonoscopy after 2 weeks confirmed significant alleviation of his rectal disuse atrophy (B). Subsequently, endoscopic submucosal dissection was performed to completely resect the lesion (C). Pathologic examination confirmed a villous adenoma with negative margins. The patient recovered uneventfully and was discharged after 5 days. Reversion of his colon was performed 3 months later. During 1 year of follow-up care, the patient was well, and no tumor recurrence was noted (D).
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