Endoscopic Submucosal Dissection Is Safe and Effective for Lesions Located at the Anorectal Junction: Analysis from Two Referral European Centers

Abstract

<b><i>Introduction:</i></b> 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. <b><i>Methods:</i></b> We performed a retrospective analysis of prospectively collected data concerning all consecutive rectal ESD procedures performed in two European centers, from 2015 to 2021. <b><i>Results:</i></b> 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 (<i>p</i> = 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 <i>en bloc</i> resection rate (100% vs. 96%, <i>p</i> = 0.204), R0 resection rate (76% vs. 75%, <i>p</i> = 0.531), curative resection rate (70% vs. 70%, <i>p</i> = 0.920), procedures’ median duration (120 min vs. 90 min, <i>p</i> = 0.072), ESD velocity (14 vs. 12 mm²/min, <i>p</i> = 0.415), histopathology result (<i>p</i> = 0.053), and the need for surgery due to a non-curative ESD (5% vs. 3%, <i>p</i> = 0.739). Also, there was no statistically significant difference that concerns delayed bleeding (7% vs. 8%, <i>p</i> = 0.709), perforation (0% vs. 5%, <i>p</i> = 0.075), or the need for readmission (2% vs. 2%, <i>p</i> = 0.939). Nevertheless, anorectal stenosis (5% vs. 0%, <i>p</i> = 0.003) and anorectal pain (9% vs. 1%, <i>p</i> = 0.002) were significantly more frequent in ARJ lesions. <b><i>Conclusion:</i></b> ESD is a safe and efficient resection technique for the treatment of rectal lesions located in the ARJ.