Underwater hybrid endoscopic submucosal dissection in a rectal polyp: a case report of a new application of "underwater endoscopy"

Background: Hybrid endoscopic submucosal dissection (ESD) has been described as an alternative to traditional ESD. This technique is less time consuming, but the en bloc resection rate is lower than in ESD. Similar to endoscopic mucosal resection, the underwater technique could improve preliminary disadvantages of hybrid ESD. Case report: We attempted a mixture resection technique of Hybrid ESD with underwater endoscopic mucosal resection (EMR). Using this approach, an underwater hybrid ESD was successfully performed without adverse events on a 71 year old woman with a 20 mm adenoma. The histologic analysis identified a tubulovillious adenoma with high grade dysplasia and tumor free margins. Discussion: Underwater hybrid ESD could be an alternative to ESD. Moreover the modification of the “underwater method” provides a suitable way to overcome the technical drawbacks of the hybrid ESD.