CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(11): E1355-E1362
DOI: 10.1055/a-0749-8735
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Endoscopic submucosal dissection for rectal neoplasia extending to the dentate line: European experience

Andreas Probst
1  Department of Gastroenterology, Klinikum Augsburg, Germany
,
Alanna Ebigbo
1  Department of Gastroenterology, Klinikum Augsburg, Germany
,
Bruno Märkl
2  Institute of Pathology, Klinikum Augsburg, Germany
,
Saskia Ting
2  Institute of Pathology, Klinikum Augsburg, Germany
,
Tina Schaller
2  Institute of Pathology, Klinikum Augsburg, Germany
,
Matthias Anthuber
3  Department of General, Visceral and Transplantation Surgery, Klinikum Augsburg, Germany
,
Carola Fleischmann
1  Department of Gastroenterology, Klinikum Augsburg, Germany
,
Helmut Messmann
1  Department of Gastroenterology, Klinikum Augsburg, Germany
› Author Affiliations
Further Information

Publication History

submitted 15 May 2018

accepted after revision 05 September 2018

Publication Date:
07 November 2018 (online)

  

Abstract

Background and study aims The ideal treatment strategy for rectal neoplasia extending to the dentate line (RNDL) is not well defined. Endoscopic mucosal resection (EMR) and submucosal dissection (ESD) compete with surgical techniques such as transanal endoscopic microsurgery (TEM). Non-Asian data and prospective data on ESD are lacking. The study aim was to evaluate the role of ESD in treatment of RNDL in a Western center.

Patients and methods Eighty-six patients with rectal adenomas were included. ESD was performed in 86 rectal adenomas including 24 RNDLs (27.9 %) and 62 lesions distant from the dentate line (72.1 %).

Results En bloc resection rate was comparable (91.7 % vs. 93.5 %, P = 0.670) between ESD for RNDL and non-RNDL. R0 resection rate was significantly lower in ESD for RNDL compared to that for non-RNDL (70.8 % vs 88.7 %; P = 0.039), but most non-R0 resection was unclear margin (Rx) and was not obvious positive margin (R1). Accordingly, the recurrence rate after ESD for RNDL (4.5 %) was not statistically different from that for non-RNDL (0 %, P = 0.275) and was lower than that previously reported for EMR. Median procedure time was 127 vs. 110 minutes (P = 0.182). Risk of delayed bleeding (20.8 % vs. 0 %, P = 0.001) and postinterventional pain (33.3 % vs. 14.5 %, P = 0.07) increased in RNDL cases, but they were managed conservatively. Incidence of stricture (4.2 % vs. 1.6 %, P = 0.483) and perforation (0 % vs. 1.6 %, P = 1.000) were similar.

Conclusions ESD is a feasible and safe resection technique for RNDLs. A randomized controlled trial comparing ESD to other methods (EMR or transanal surgery) is warranted.