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Título

ENDOSCOPIC ULTRASOUND: A TOOL TO STAGE EARLY TUMORS IN THE RIGHT COLON

Resumo

Lateral spreading tumors (LST) are precursors of colorectal cancer (CRC), the risk of metastasis depends on endoscopic and histological characteristics. The most frequently raised clinical question is whether the patient has an endoscopically resectable lesion or needs surgical intervention, been the LST morphology the main characteristic that determines this approach.
We present a case of a 61-year-old female who presented to our institution to perform a colonoscopy due to an abdominal computed tomography showing thickening of the cecum. Colonoscopy showed a granular nodular-mixed LST with approximately 5 cm in the cecum. The lesion had a predominant JNET 2B and Kudo IV pattern with some areas showing JNET 3, Kudo Vn pattern raising the concern of massive submucosal invasion. Our institution has extensive expertise in performing endoscopic submucosal dissection (ESD) and this could be an excellent therapeutic approach. Due to concern of depth invasion, we performed an endoscopic ultrasound (EUS) of the region. Using a front-view radial echoendoscope, with the aid of an overtube to facilitate the passage through the sigmoid, the cecum was easily reached. The endosonography analysis showed no signs of submucosal invasion. But due to the KUDO and JNET patterns in some areas, the patient was referred to surgical resection. A right hemicolectomy was performed. The histopathological assessment was consistent with an adenocarcinoma ``in situ ``restrict to the mucosa.
This case shows that EUS in the right colon is feasible and can bring important information to benefit patients. The use of EUS in rectal lesions is well known, but further advances in the study of the colon with this tool are necessary.

Palavras-Chave

Colorectal cancer, Colonoscopy, Endoscopic Ultrasound, EUS