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Transanal endoscopic microsurgical submucosal dissection (TEM-ESD) for rectal adenomas: a retrospective cohort study of 145 consecutive cases

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Abstract

Purpose

Transanal endoscopic microsurgery (TEM) and endoscopic submucosal dissection (ESD) are currently the two most popular methods for resecting large rectal adenomas en bloc. However, damage to the mesorectum in the case of TEM, plus the technical challenges and long procedure times of flexible ESD, are major disadvantages of these procedures. Transanal endoscopic microsurgical submucosal dissection (TEM-ESD) is a new technique, combining the ergonomic features of TEM with the minimally invasive approach of ESD. The aim of our study was to assess the feasibility and safety of TEM-ESD for resection of large rectal adenomas.

Methods

We retrospectively analyzed all TEM-ESD procedures performed in Karlsruhe Municipal Hospital between 2012 and 2019, isolated all cases of adenomas, and analyzed the perioperative and follow-up data of the patients.

Results

We identified 145 cases matching our criteria. The median size of the lesions was 4.2 cm, and the median operating time was 45 min. The en bloc resection rate was 100%, and the complete en bloc resection rate was 78.6%. The overall morbidity rate was 6.9%. In a median follow-up period of 24 months, there was a local recurrence in 4.8% of the cases.

Conclusions

TEM-ESD is a safe and feasible therapeutic option for resecting large rectal adenomas, offering high en bloc resection and low recurrence rates combined with short operating time and low morbidity.

Trial Registration Number (ClinicalTrials.gov)

NCT04870931.

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Data availability

The data and material were collected upon special request and after the approval of the local ethics committee was granted.

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Authors and Affiliations

  1. Central Interdisciplinary Endoscopy Department, Department of Surgery, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Konstantinos Kouladouros & Jörg Baral

  2. Surgery Department, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany

    Konstantinos Kouladouros & Jörg Baral

Authors
  1. Konstantinos Kouladouros
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  2. Jörg Baral
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Contributions

Both authors contributed equally to the conception of the study and the data analysis. J. Baral first described the technique studied and performed most of the resections. K. Kouladouros wrote the manuscript. Both authors revised and approved the manuscript.

Corresponding author

Correspondence to Konstantinos Kouladouros.

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Ethics statement/consent to participate

Approval from the local ethics committee (University of Heidelberg) was acquired (Approval Number 2021–801). All the data were pseudonymized and retrospectively analyzed, so no informed consent was necessary according to the ethics committee.

Competing interests

Jörg Baral declares that he has a consulting contract with Richard Wolf GmbH, Knittlingen, Germany. Konstantinos Kouladouros has none to declare.

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Kouladouros, K., Baral, J. Transanal endoscopic microsurgical submucosal dissection (TEM-ESD) for rectal adenomas: a retrospective cohort study of 145 consecutive cases. Langenbecks Arch Surg 407, 2423–2430 (2022). https://doi.org/10.1007/s00423-022-02562-0

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