Introduction: Endoscopic submucosal dissection (ESD) is a well-established resection technique for colorectal superficial tumors, but its role in the treatment of anorectal junction (ARJ) lesions still remains to be determined. With this study, we aimed to evaluate the feasibility, safety, and efficacy of ESD for the resection of ARJ lesions, in comparison to more proximal rectal lesions. Methods: We performed a retrospective analysis of prospectively collected data concerning all consecutive rectal ESD procedures performed in two European centers, from 2015 to 2021. Results: A total of two hundred and fifty-two rectal lesions were included. Sixty (24%) were ARJ lesions, and the remaining 192 (76%) were located proximally. Technical success was achieved in 248 procedures (98%), and its rate was similar in both locations (p = 0.246). Most of the lesions presented high-grade dysplasia/Tis adenocarcinoma (54%); 36 (15%) had submucosal adenocarcinoma, including 20 superficial (sm1) and 16 deeply invasive (#x3e;SM1) T1 cancers. We found no differences between ARJ and rectal lesions in regard to en bloc resection rate (100% vs. 96%, p = 0.204), R0 resection rate (76% vs. 75%, p = 0.531), curative resection rate (70% vs. 70%, p = 0.920), procedures’ median duration (120 min vs. 90 min, p = 0.072), ESD velocity (14 vs. 12 mm²/min, p = 0.415), histopathology result (p = 0.053), and the need for surgery due to a non-curative ESD (5% vs. 3%, p = 0.739). Also, there was no statistically significant difference that concerns delayed bleeding (7% vs. 8%, p = 0.709), perforation (0% vs. 5%, p = 0.075), or the need for readmission (2% vs. 2%, p = 0.939). Nevertheless, anorectal stenosis (5% vs. 0%, p = 0.003) and anorectal pain (9% vs. 1%, p = 0.002) were significantly more frequent in ARJ lesions. Conclusion: ESD is a safe and efficient resection technique for the treatment of rectal lesions located in the ARJ.
GE Port J Gastroenterol

中文翻译：

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内镜粘膜下剥离术对位于肛门直肠交界处的病变安全有效：来自两个转诊欧洲中心的分析

简介：内镜黏膜下剥离术 (ESD) 是一种行之有效的结直肠浅表肿瘤切除技术，但其在治疗肛门直肠交界处 (ARJ) 病变中的作用仍有待确定。通过这项研究，我们旨在评估 ESD 与更近端直肠病变相比，用于切除 ARJ 病变的可行性、安全性和有效性。方法：我们对 2015 年至 2021 年在两个欧洲中心进行的所有连续直肠 ESD 手术的前瞻性收集数据进行了回顾性分析。结果：总共包括 252 个直肠病变。60 个 (24%) 是 ARJ 病变，其余 192 个 (76%) 位于近端。248 次手术 (98%) 实现了技术成功，两个地点的成功率相似 ( p = 0.246)。大多数病灶表现为高度异型增生/Tis 腺癌 (54%)；36 例 (15%) 患有粘膜下腺癌，包括 20 例浅表 (sm1) 和 16 例深度浸润 (#x3e;SM1) T1 期癌症。我们发现 ARJ 和直肠病变在整块切除率（100% 对 96%，p = 0.204）、R0 切除率（76% 对 75%，p = 0.531）、根治性切除率（70 % 对比 70%，p= 0.920）、程序的中位持续时间（120 分钟对 90 分钟，p = 0.072）、ESD 速度（14 对 12 mm ² /min，p = 0.415）、组织病理学结果（p = 0.053）以及对因非治愈性 ESD 而进行手术（5% 对 3%，p = 0.739）。此外，延迟出血（7% 对 8%，p = 0.709）、穿孔（0% 对 5%，p = 0.075）或需要再入院（2% 对 2 %，p = 0.939）。然而，肛门直肠狭窄（5% 对 0%，p = 0.003）和肛门直肠疼痛（9% 对 1%，p = 0.002）在 ARJ 病变中明显更常见。结论： ESD 是一种安全有效的切除技术，用于治疗位于 ARJ 的直肠病变。
GE Port J 胃肠醇