Introduction

Large rectal adenomas often spread to the upper part of the anal canal. In this study were retrospectively analyzed 13 of 40 rectal lesions, operated by endoscopic submucosal dissections in 2018-2025, which were localized in lower rectum. 7 lesions have spread on anal canal and 6 lesions were localized in lower rectum without spreading on anal canal. The study compared the risk of intraprocedural bleeding, completeness of removal, duration of dissection, pain syndrome, and red blood cell indicators based on the size and location of the lesions.

Aims & Methods

A retrospective analysis was conducted on 40 Endoscopic Submucosal Dissections (ESD) of rectal lesions, all performed by a single operator at a single center. Two cases of NETs treated by ESD, two cases of synchronous colorectal locations resected in a single procedure, three ESD cases of recurrent adenomas following endoscopic or surgical treatment, two cases with deeply invasive carcinomas, and eighteen cases with rectal tumors without involvement of the lower rectum and anal canal were excluded. Seven ESD cases of anorectal lesions ranging from 20 to 170 mm in size, and six lower rectal lesions ranging from 30 to 80 cm were compared. Information about duration, location and size was taken from protocol of the operation and reviewed by photo and video fixation of procedures. Medical documentation was checked for red blood indicators and treatment of pain syndrome. Additionally, a follow-up phone call for all patients will be conducted two weeks after ESD.

Results

All lesions were removed in a single block. Only one tumor was fragmentated during the extraction. Coagulation forceps was needed in 5 of 7 cases in anorectal ESD group and 4 of 6 cases between lower rectal lesions. Forceps were needed in all cases over 70 mm in size. Two cases of massive bleeding were documented in anorectal group: one intraprocedural bleeding and one delayed bleeding. All patients in the low rectal group were discharged the day after ESD. In the anorectal group, four patients were discharged on the second, third, fourth, and fifth day following the procedure. Patients in the anorectal group reported symptoms within two weeks after dissection, including pain, episodes of fever, and increased hair loss (in cases involving significant intraprocedural bleeding).

Conclusion

Endoscopic submucosal dissection in lower rectum and anal canal is an effective modality for treatment of large benign tumors. But such operation, especially in cases on anorectal lesions has high risk of massive intraprocedural and delayed bleeding, longer hospital staying and longer recovery after treatment.