Invasive rectal cancer treated with a combination of endoscopic submucosal dissection and chemoradiation

A 68‐year‐old man underwent total colonoscopy because of a positive fecal occult blood test. A polypoid lesion ( I s +  IIa ), 20 mm in size, was detected in the very lower part of the rectum. A large reddish nodule suggesting invasive carcinoma was seen on conventional view. Magnifying chromoendoscopy, however, disclosed a non‐invasive pit pattern in that part. Moreover, magnifying narrow band imaging showed a type IIIA capillary pattern. Therefore, endoscopic submucosal dissection was successfully conducted for en bloc resection. Histologically, it was a rectal submucosal invasive carcinoma deeply invading into thesubmucosal layer with vascular invasion. Although additional surgical treatment was suggested, the patient refused the proposal and received chemoradiation therapy to avoid a permanent colostomy. Periodic evaluation revealed no local or distant metastasis 3 years thereafter.