Technical Feasibility of Endoscopic Submucosal Dissection for Lower Rectal Tumors

Abstract

Introduction: Large (>2cm) rectal adenomas are usually treated by transanal endoscopic microsurgery or endoscopic piecemeal mucosal resection (EPMR). Recently, endoscopic submucosal dissection (ESD) has demonstrated to be effective for the en bloc resection of colorectal lesions. We aimed to investigate the feasibility and safety of ESD for lower rectal tumors. Methods: Between June 2009 and August 2014, 39 patients with lower rectal tumors (≥2 cm) were treated by ESD at our department. Data were examined and analyzed retrospectively according to database and histopathological reports, with respect to histopathological diagnosis, procedure time, en bloc resection rate and complications. Results: The mean adenoma size was 45.6 ± 24.4 mm and the mean distance from the anal verge was 33.5 ± 16.2mm. Among all the lesions, 26 (66.6%) were laterally spreading tumors (granular type), including 2 homogeneous type (5.1%) and 24 nodular mixed type (61.5%) lesions, and the most frequent histological type was tubulovillous adenoma (17/34, 50.0%) (Table 1). The mean procedure time was 100.1 ± 64.3 minutes. En bloc resection and en bloc R0 resection were achieved in 92.3% (36/39) and 87.1% (34/39) of patients, respectively. Perforation occurred in 2 patient (5.1%), which was treated by endoclip. Postoperative bleeding occurred in 2 patients (5.1%) and was managed conservatively (Figure 1, Table 2).Figure 1Table 1: Clinical features of lower rectal lesions (n=39)Table 2: Clinical outcomes and complicationsConclusion: ESD is safe and feasible for the treatment of non-invasive lower rectal tumors, with a low complication rate. To prove its long-term efficacy, a multicenter prospective study with large volume should be conducted in future.Figure 2