{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:33:43Z","timestamp":1792481623984,"version":"4.5.0"},"reference-count":10,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Electrolyte depletion syndrome (EDS), also known as McKittrick\u2013Wheelock syndrome, is a rare but life\u2010threatening condition caused by secretory diarrhea from colorectal villous tumors, often accompanied by severe electrolyte imbalances and renal dysfunction. Large, circumferential tumors have traditionally been managed with surgical resection, frequently requiring stoma formation. Recently, endoscopic submucosal dissection (ESD) has emerged as a minimally invasive alternative, although its feasibility for large rectal tumors remains limited. We report a case of EDS caused by a giant circumferential rectal villous tumor measuring approximately 28\u00a0cm, successfully treated with ESD. A 58\u2010year\u2010old man presented with persistent diarrhea, electrolyte disturbances, and acute kidney injury. Imaging and endoscopy revealed a circumferential villous tumor extending from the anal verge to the rectosigmoid colon, diagnosed as a villous adenoma without malignancy on biopsy. After careful discussion between the departments of gastrointestinal surgery and gastroenterology, ESD under general anesthesia was selected to avoid colectomy and stoma creation. En bloc resection of a 280 \u00d7 240\u00a0mm tumor was achieved without major complications. Prophylactic steroid injection and systemic steroid administration prevented post\u2010ESD stricture. Histopathology revealed adenocarcinoma with minimal submucosal invasion (800 \u00b5m), no lymphovascular invasion, and negative resection margins, indicating curative resection. At 6\u2010month follow\u2010up, no recurrence or stricture was observed. This case highlights the potential of ESD as a definitive and less invasive treatment option for EDS caused by large rectal villous tumors when performed with appropriate therapeutic planning and meticulous postoperative care.<\/jats:p>","DOI":"10.1002\/deo2.70197","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T10:11:42Z","timestamp":1756462302000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Electrolyte Depletion Syndrome due to a 28\u00a0cm Rectal Villous Tumor: Successful Endoscopic Resection of One of the Largest Tumors Reported to Date\u2014A Case Report"],"prefix":"10.1002","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9694-4667","authenticated-orcid":false,"given":"Toshifumi","family":"Iida","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Omori Red Cross Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9766-509X","authenticated-orcid":false,"given":"Hideyuki","family":"Chiba","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Omori Red Cross Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ai","family":"Hirohata","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Omori Red Cross Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akimichi","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Omori Red Cross Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Ebisawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Omori Red Cross Hospital  Tokyo 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Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02070718"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1159\/000382070"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12328-015-0597-4"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-021-08916-x"},{"key":"e_1_2_7_6_1","first-page":"1151","article-title":"Thirty\u2010seven Cases of Villous Adenoma of the Large Bowel","volume":"17","author":"Sasaki T.","year":"1982","journal-title":"Stomach Intestine"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1778-3448"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1569667"},{"issue":"11","key":"e_1_2_7_9_1","article-title":"Endoscopic Resection\u2011Related Colorectal Strictures: Risk Factors, Management, and Long\u2011Term 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