Endoscopic submucosal dissection for anorectal tumor with hemorrhoids close to the dentate line: a multicenter study of Hiroshima GI Endoscopy Study Group
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The lower rectum close to the dentate line has distinct characteristics, making endoscopic submucosal dissection (ESD) of tumors challenging. We assessed clinical outcomes of ESD for such patients with hemorrhoids.
Sixty-four patients (mean age, 68 years) underwent ESD for anorectal tumors close to the dentate line. We divided patients into those with (Group A, 45 patients) and without hemorrhoids (Group B, 19 patients). We examined en bloc and histological en bloc resection rates, procedure time, complication rates, and postoperative prognosis after ESD.
The mean tumor size was 43 mm. Histologic diagnoses were adenoma (42 %, 27/64), carcinoma in situ (44 %, 28/64), and T1 carcinoma (14 %, 9/64). There was no significant difference in en bloc resection (93 %, 42/45 vs. 95 %, 18/19) or postoperative bleeding rates (16 %, 7/45 vs. 11 %, 2/19) between Groups A and B, respectively. The mean procedural durations were 120 and 124 min, respectively, in Groups A and B. No perforations occurred. There was no significant difference in postoperative anal pain rate between Groups A (18 %, 8/45) and B (16 %, 3/19), and it resolved within a few days in all cases. There was one case of stricture in Group B. Two patients with T1 carcinoma underwent additional surgery, one underwent chemotherapy, and five had no additional treatment. No recurrence occurred during the follow-up period of 38 months.
ESD is safe and effective for anorectal tumors close to the dentate line in patients with hemorrhoids.
KeywordsEndoscopic submucosal dissection Rectal tumor Dentate line Hemorrhoid
This study was conducted with a Grant-in-Aid from the Japan Agency for Medical Research and Development, AMED (15ck0106102h0102).
Compliance with ethical standards
Yuzuru Tamaru, Shiro Oka, Shinji Tanaka, Yuko Hiraga, Masaki Kunihiro, Shinji Nagata, Akira Furudoi, Yuki Ninomiya, Naoki Asayama, Kenjiro Shigita, Soki Nishiyama, Nana Hayashi, and Kazuaki Chayama have no conflicts of interest or financial ties to disclose.
- 2.Oka S, Tanaka S, Saito Y, Iishi H, Kudo SE, Ikematsu H, Igarashi M, Saitoh Y, Inoue Y, Kobayashi K, Hisabe T, Tsuruta O, Sano Y, Yamano H, Shimizu S, Yahagi N, Watanabe T, Nakamura H, Fujii T, Ishikawa H, Sugihara K, Colorectal Endoscopic Resection Standardization Implementation Working Group of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan (2015) Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol 110:697–707CrossRefPubMedGoogle Scholar
- 3.Standring S (2008) Gray’s anatomy: the anatomical basis of clinical practice. Churchill Livingstone, LondonGoogle Scholar
- 12.Antillon MR, Bartalos CR, Miller ML, Diaz-Arias AA, Ibdah JA, Marshall JB (2008) En bloc endoscopic submucosal dissection of a 14-cm laterally spreading adenoma of the rectum with involvement to the anal canal: expanding the frontiers of endoscopic surgery (with video). Gastrointest Endosc 67:332–337CrossRefPubMedGoogle Scholar
- 14.Fujimoto K, Fujishiro M, Kato M, Higuchi K, Iwakiri R, Sakamoto C, Uchiyama S, Kashiwagi A, Ogawa H, Murakami K, Mine T, Yoshino J, Kinoshita Y, Ichinose M, Matsui T (2014) Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc 26:1–14CrossRefPubMedGoogle Scholar
- 16.Tanaka S, Kashida H, Saito Y, Yahagi N, Yamano H, Saito S, Hisabe T, Yao T, Watanabe M, Yoshida M, Kudo SE, Tsuruta O, Sugihara K, Watanabe T, Saitoh Y, Igarashi M, Toyonaga T, Ajioka Y, Ichinose M, Matsui T, Sugita A, Sugano K, Fujimoto K, Tajiri H (2015) JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 27:417–434CrossRefPubMedGoogle Scholar
- 19.Japanese Society for Cancer of the Colon and Rectum (JSCCR) (2014) JSCCR guidelines for the treatment of colorectal carcinoma. Kanehara Shuppan Co., Tokyo (in Japanese) Google Scholar
- 28.Yamaguchi N, Isomoto H, Nakayama T, Hayashi T, Nishiyama H, Ohnita K, Takeshima F, Shikuwa S, Kohno S, Nakao K (2011) Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc 73:1115–1121CrossRefPubMedGoogle Scholar
- 32.Toyonaga T, Man-i M, Fujita T, East JE, Nishino E, Ono W, Morita Y, Sanuki T, Yoshida M, Kutsumi H, Inokuchi H, Azuma T (2010) Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum. Endoscopy 43:714–722CrossRefGoogle Scholar
- 36.Kawaguti FS, Nahas CS, Marques CF, Martins BC, Retes FA, Medeiros RS, Hayashi T, Wada Y, de Lima MS, Uemura RS, Nahas SC, Kudo SE, Maluf-Filho F (2014) Endoscopic submucosal dissection versus transanal endoscopic microsurgery for the treatment of early rectal cancer. Surg Endosc 28:1173–1179CrossRefPubMedGoogle Scholar
- 37.Park SU, Min YW, Shin JU, Choi JH, Kim YH, Kim JJ, Cho YB, Kim HC, Yun SH, Lee WY, Chun HK, Chang DK (2012) Endoscopic submucosal dissection or transanal endoscopic microsurgery for nonpolypoid rectal high grade dysplasia and submucosa-invading rectal cancer. Endoscopy 44:1031–1036CrossRefPubMedGoogle Scholar