{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:15:03Z","timestamp":1790694903518,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Local full\u2010thickness resection techniques for rectal cancer are limited by lesion size, location, or poor margin delineation. We aimed to evaluate the feasibility of endoscopic knife\u2010assisted full\u2010thickness resection (kFTR) guided by the pocket\u2010detection method (PDM) for deeply invasive rectal cancer.<\/jats:p><jats:p>Consecutive posterior\u2010lateral rectal lesions suspected of deep submucosal invasion treated at a tertiary care center from February to October 2024 were retrospectively included. kFTR guided by PDM involved creating a submucosal pocket to detect and isolate the suspected invasive component (muscle\u2010retracting sign), followed by muscularis propria incision and full\u2010thickness resection.<\/jats:p><jats:p>Technical success, accuracy of detecting deep submucosal invasion, and en\u2010bloc resection rates were 100%. The median procedure time was 141.5 [IQR 123.7\u2013179.5] minutes and the median hospitalization was 1 [IQR 1\u20137] day. No adverse events occurred. Histopathology showed R1\u2010vertical margin in patient 1 (pT2 adenocarcinoma) and R0 resection in patients 2, 3, and 4 (pT1bsm3) after refinement of the procedure to include a \u22653\u00a0mm muscularis propria margin around the suspected invasive component. There was no recurrence at the first endoscopic follow\u2010up of patients 1, 2, and 4. Patient 3 was sent to surgical low anterior resection due to multiple high\u2010risk histological features. The previous kFTR did not impair surgery (no residual rectal carcinoma and 1\/17 positive lymph nodes).<\/jats:p><jats:p>Endoscopic kFTR guided by the PDM may be a feasible organ\u2010preserving treatment for the detection and resection of deeply invasive posterior rectal cancer. Future studies are needed to ascertain whether rectal kFTR could represent a viable alternative to conventional surgical local excision techniques.<\/jats:p>","DOI":"10.1002\/deo2.70116","type":"journal-article","created":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T04:46:02Z","timestamp":1745383562000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Knife\u2010assisted full\u2010thickness resection guided by the pocket\u2010detection method for posterior deeply invasive rectal cancer: A novel endoscopic approach (with video)"],"prefix":"10.1002","volume":"5","author":[{"given":"Maria Eva","family":"Argenziano","sequence":"first","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology University Hospital Ghent (UZ Ghent)  Ghent Belgium"},{"name":"Faculty of Medicine and Health Sciences University of Ghent  Ghent Belgium"},{"name":"Clinic of Gastroenterology, Hepatology and Emergency Digestive Endoscopy Universit\u00e0 Politecnica delle Marche  Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0285-9949","authenticated-orcid":false,"given":"Andrea","family":"Sorge","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology University Hospital Ghent (UZ Ghent)  Ghent Belgium"},{"name":"Department of Pathophysiology and Transplantation University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Hoorens","sequence":"additional","affiliation":[{"name":"Department of Pathology University Hospital of Ghent (UZ Ghent)  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Montori","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology University Hospital Ghent (UZ Ghent)  Ghent Belgium"},{"name":"Clinic of Gastroenterology, Hepatology and Emergency Digestive Endoscopy Universit\u00e0 Politecnica delle Marche  Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3529-5040","authenticated-orcid":false,"given":"Pieter Jan","family":"Poortmans","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology University Hospital Ghent (UZ Ghent)  Ghent Belgium"},{"name":"Faculty of Medicine and Health Sciences University of Ghent  Ghent Belgium"},{"name":"Department of Gastroenterology &amp; Hepatology University Hospital Brussels (UZ Brussels)  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander","family":"Smeets","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology University Hospital Ghent (UZ Ghent)  Ghent Belgium"},{"name":"Faculty of Medicine and Health Sciences University of Ghent  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamas","family":"Tornai","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology University Hospital Ghent (UZ Ghent)  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn K.","family":"Debels","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology University Hospital Ghent (UZ Ghent)  Ghent Belgium"},{"name":"Faculty of Medicine and Health Sciences University of Ghent  Ghent Belgium"},{"name":"Department of Gastroenterology &amp; Hepatology University Hospital Brussels (UZ Brussels)  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lobke","family":"Desomer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology University Hospital Ghent (UZ Ghent)  Ghent Belgium"},{"name":"Department of Gastroenterology &amp; Hepatology  Roeselare Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0226-0434","authenticated-orcid":false,"given":"David J.","family":"Tate","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology University Hospital Ghent (UZ Ghent)  Ghent Belgium"},{"name":"Faculty of Medicine and Health Sciences University of Ghent  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,22]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005523"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2022.04.010"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-017-5910-5"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1748-8573"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-022-09853-z"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-021-08494-y"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.14631"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-0915-1847"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1127-3092"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vgie.2024.11.004"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1391665"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365521.2010.495416"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2023.06.009"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2021.09.039"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-010-0927-z"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-021-02558-w"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.12657"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2011.02778.x"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.11.032"}],"container-title":["DEN Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/deo2.70116","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T12:44:05Z","timestamp":1746189845000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/deo2.70116"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1002\/deo2.70116"],"URL":"https:\/\/doi.org\/10.1002\/deo2.70116","archive":["Portico"],"relation":{},"ISSN":["2692-4609","2692-4609"],"issn-type":[{"value":"2692-4609","type":"print"},{"value":"2692-4609","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]},"assertion":[{"value":"2024-12-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70116"}}