Rectal neoplasia extending to the dentate line: clinical outcomes of endoscopic submucosal dissection

Abstract

Background

The European Society of Gastrointestinal Endoscopy (ESGE) and the Japan Gastroenterological Endoscopy Society (JGES) give no specific recommendations on the best treatment for colorectal neoplasia involving the dental line (DLCN).

Objective

Aim of this study was to analyse efficacy and safety of Endoscopic Submucosal Dissection in the treatment of colorectal neoplasia involving the dentate line (DLCN) compared to non-DLCN.

Design

Retrospective study.

Patients

We retrospectively evaluated all consecutive patients undergoing ESD for rectal neoplasia at two endoscopical tertiary referral centers (Italy and Japan) from January 2008 to December 2019.

Main outcome measures

Anthropometric, clinical, procedural, and follow-up data was collected, analysed, and compared between patients with DLCN and patients with non-DLCN.

Results

Overall, 314 patients were enrolled (163 female, 51.9%). Mean age was 68 years (range, 32–92 years). En-bloc resection was achieved in 311/314 (99%) patients. Lesion size was higher in DLCN group than in the non-DLCN group (46.1 vs 38.9 mm; p = .03). Submucosal invasion rate was also higher in the DLCN group (29.6 vs 18.4%, p = .04). Procedure time was significantly longer in the DLCN group, (89.6 vs. 73.1 min; p = .002). Hospitalization length following ESD was similar in both groups.

Limitations

Retrospective study design.

Conclusions

ESD seems to be safe and effective in the treatment of colorectal neoplasia involving the dentate line and can be considered the best therapeutic strategy.

Keywords:

• Rectal neoplasia
• ESD
• dentate line

Author contributions

GA, TK, JH, KH contributed to conception and design. GA, TK, KH contributed to acquisition of data. CH, GA, GA contributed to analysis and interpretation of data. GA, TK contributed to drafting of the article. GA, FDM, KH contributed to critical revision of the article. CH and GA contributed to statistical analysis. GC, FDM, KH approved the final draft of the article. All authors listed have contributed substantially to the design, data collection and analysis, and editing of the manuscript.

Disclosure statement

The authors have no conflict of interest related to the manuscript.