Yuzuru Tamaru1,2, Shiro Oka3,4, Shinji Tanaka1,2, Yuko Hiraga2, Masaki Kunihiro2, Shinji Nagata2, Akira Furudoi2, Yuki Ninomiya2,5, Naoki Asayama2,5, Kenjiro Shigita2,5, Soki Nishiyama2,5, Nana Hayashi2,5, Kazuaki Chayama5. 1. Department of Endoscopy, Hiroshima University Hospital, 1-2-3, Kasumi Minami-ku, Hiroshima, Japan. 2. Hiroshima GI Endoscopy Study Group, Hiroshima, Japan. 3. Department of Endoscopy, Hiroshima University Hospital, 1-2-3, Kasumi Minami-ku, Hiroshima, Japan. oka4683@hiroshima-u.ac.jp. 4. Hiroshima GI Endoscopy Study Group, Hiroshima, Japan. oka4683@hiroshima-u.ac.jp. 5. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: ESD is safe and effective for anorectal tumors close to the dentate line in patients with hemorrhoids.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: ESD is safe and effective for anorectal tumors close to the dentate line in patients with hemorrhoids.
Authors: T Toyonaga; M Man-i; T Fujita; J E East; E Nishino; W Ono; Y Morita; T Sanuki; M Yoshida; H Kutsumi; H Inokuchi; T Azuma Journal: Endoscopy Date: 2010-08-30 Impact factor: 10.093
Authors: Andreas Probst; Alanna Ebigbo; Bruno Märkl; Saskia Ting; Tina Schaller; Matthias Anthuber; Carola Fleischmann; Helmut Messmann Journal: Endosc Int Open Date: 2018-11-07