Endoscopic submucosal dissection for anorectal tumor with hemorrhoids close to the dentate line: a multicenter study of Hiroshima GI Endoscopy Study Group

Tamaru, Yuzuru; Oka, Shiro; Tanaka, Shinji; Hiraga, Yoshikazu; Kitajima, Masaki; Nagata, Shinji; Furudoi, Akira; Asayama, Naoki; Shigita, Kenjiro; Nishiyama, S; Hayashi, Nana; Chayama, Kazuaki

doi:10.1007/s00464-016-4761-9

Cited by 32 publications

(50 citation statements)

References 37 publications

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“…Due to the expanding structural feature of the rectum and the contraction of the anal sphincter, it is difficult to position therapeutic devices parallel to the submucosa of the rectal wall and resect the lesion in an en bloc fashion. However, in this study, the rate of en bloc resection was high (93.9%), which is comparable to the results of ESD for LST in the rectum and for rectal tumors extending to the dentate line . However, the en bloc R0 resection rate was 83.7% for LST‐DL, which is somewhat higher than the en bloc R0 resection rates for ESD of colorectal LST and anorectal tumors.…”

Section: Discussionsupporting

confidence: 67%

“…described long‐term outcomes of ESD for LST, and reported that the en bloc R0 resection rate was 83.1%. However, the anatomical features of the rectum, in addition to the frequent coexistence of hemorrhoids, render ESD for LST involving the dentate line technically challenging . To our knowledge, only a few studies have demonstrated the efficacy and safety of ESD for rectal tumors that extend to the dentate line.…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of endoscopic submucosal dissection for laterally spreading tumors involving the dentate line

Guo

Ling

Wang

et al. 2019

J of Digest Diseases

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Objective Endoscopic submucosal dissection (ESD) for laterally spreading tumors (LST) involving the dentate line (LST‐DL) is challenging because of the specific anatomical features of the anorectum. This study aimed to evaluate the efficacy and safety of ESD for LST‐DL. Methods Consecutive patients with LST‐DL who had undergone ESD at our hospital between January 2010 and December 2015 were retrospectively enrolled in this study. Rates of en bloc resection, R0 resection, and complications, pathological characteristics, and tumor recurrence were analyzed and compared with those of LST in the rectum not involving the dentate line (LST‐NDL). Results Altogether 49 patients with LST‐DL (median age 63 years; 39 women; median lesion size 57 mm; median follow‐up period of 24 months) and 96 patients with LST‐NDL (median age 67 years; 31 women; median lesion size 47 mm; median follow‐up period of 31 months) were enrolled. En bloc resection (93.9% [46/49] vs 94.8% [91/96]) and en bloc R0 resection rates (83.7% [41/49] vs 88.5% [85/96]), respectively, for LST‐DL and LST‐NDL, with no significant differences. However, ESD for LST‐DL had a longer procedure time (77 min vs 54 min, P = 0.02), a greater postprocedural perianal pain rate (28.6% vs 0%, P < 0.001), and more anal strictures (4.1% vs 0%, P = 0.04). The complication rates of perforation, bleeding and fever, recurrence rate, and pathological characteristics did not differ between the two groups. Conclusions ESD is a safe and effective therapeutic modality for LST‐DL. However, this procedure should be performed by experienced endoscopists and the difficulty needs to be fully considered.

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Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of endoscopic submucosal dissection for laterally spreading tumors involving the dentate line

Guo

Ling

Wang

et al. 2019

J of Digest Diseases

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“…There are a few reports on use of gastric ESD in children[7-9]. Further, there are a couple of reports showing that ESD is useful for treating anorectal tumors close to the dentate line[10,11]. This procedure is an attractive option for en bloc resection of large sessile or flat colorectal lesions and is associated with very low recurrence rates.…”

Section: Discussionmentioning

confidence: 99%

Case of pediatric traditional serrated adenoma resected via endoscopic submucosal dissection

Kondo

Mori

Nishiyama

et al. 2017

WJG

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Traditional serrated adenoma (TSA) is a type of serrated polyp of the colorectum and is thought to be a precancerous lesion. There are three types of serrated polyps, namely, hyperplastic polyps, sessile serrated adenomas/polyps, and TSAs. TSA is the least common of the three types and accounts for about 5% of serrated polyps. Here we report a pediatric case of TSA that was successfully resected by endoscopic submucosal dissection (ESD). This rare case report describes a pediatric patient with no family history of colonic polyp who was admitted to our hospital with hematochezia. On colonoscopy, we found a polypoid lesion measuring 10 mm in diameter in the lower rectum. We selected ESD as a surgical option for en bloc resection, and histopathological examination revealed TSA. The findings in this case suggest that TSA with precancerous potential can occur in children, and that ESD is useful for treating this lesion.

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“…Lesions extending to the anorectum and dentate line are especially challenging to resect with endoscopic techniques as a result of difficult access and visualization and pain due to the somatic sensory innervation, and there may be a lower threshold for surgical management in these cases 97,98. ESD is a safe and highly effective technique for such lesions, even in the presence of hemorrhoids, with minimal risk of bleeding and very low risk of recurrence 98–100…”

Section: Introductionmentioning

confidence: 99%

“…ESD is a safe and highly effective technique for such lesions, even in the presence of hemorrhoids, with minimal risk of bleeding and very low risk of recurrence 98–100…”

Section: Introductionmentioning

confidence: 99%

Colorectal endoscopic submucosal dissection: patient selection and special considerations

Emmanuel¹,

Gulati²,

Burt³

et al. 2017

CEG

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Endoscopic submucosal dissection (ESD) enables en bloc resection of large complex colorectal superficial neoplastic lesions, resulting in very low rates of local recurrence, high-quality pathologic specimens for accurate histopathologic diagnosis and potentially curative treatment of early adenocarcinoma without resorting to major surgical resection. The safety and efficacy of the technique, which was pioneered in the upper gastrointestinal tract, has been established by the consistently impressive outcomes from expert centers in Japan and some other eastern countries. However, ESD is challenging to perform in the colorectum and there is a significant risk of complications, particularly in the early stages of the learning curve. Early studies from western centers raised concerns about the high complication rates, and the impressive results from Japanese centers were not replicated. As a result, many western endoscopists are skeptical about the role of ESD and few centers have incorporated the technique into their practice. Nevertheless, although the distribution of expertise, referral centers and modes of practice may differ in Japan and western countries, ESD has an important role and can be safely and effectively incorporated into western practice. Key to achieving this is meticulous lesion assessment and selection, appropriate referral to centers with the necessary expertise and experience and application of the appropriate technique individualized to the patient. This review discusses the advantages, risks and benefits of ESD to treat colorectal lesions and the importance of preprocedure lesion assessment and in vivo diagnosis and outlines a pragmatic rationale for appropriate lesion selection as well as the patient, technical and institutional factors that should be considered.

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Endoscopic submucosal dissection for anorectal tumor with hemorrhoids close to the dentate line: a multicenter study of Hiroshima GI Endoscopy Study Group

Abstract: ESD is safe and effective for anorectal tumors close to the dentate line in patients with hemorrhoids.

Cited by 32 publications

References 37 publications

Clinical outcomes of endoscopic submucosal dissection for laterally spreading tumors involving the dentate line

Clinical outcomes of endoscopic submucosal dissection for laterally spreading tumors involving the dentate line

Case of pediatric traditional serrated adenoma resected via endoscopic submucosal dissection

Colorectal endoscopic submucosal dissection: patient selection and special considerations

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