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Review
. 2023 Jul 19;12(14):4777.
doi: 10.3390/jcm12144777.

Endoscopic Submucosal Dissection, Endoscopic Mucosal Resection, and Transanal Minimally Invasive Surgery for the Management of Rectal and Anorectal Lesions: A Narrative Review

Pedro Moreira  1 , Pedro Marílio Cardoso  1   2 , Guilherme Macedo  1   2 , João Santos-Antunes  1   2   3   4
Affiliations
Review

Endoscopic Submucosal Dissection, Endoscopic Mucosal Resection, and Transanal Minimally Invasive Surgery for the Management of Rectal and Anorectal Lesions: A Narrative Review

Pedro Moreira et al. J Clin Med. .

Abstract

Endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and transanal minimally invasive surgery (TAMIS) are modern techniques that now play a crucial role in the treatment of colorectal lesions. ESD is a minimally invasive endoscopic procedure that allows for the resection of lesions of any size in a single piece, with clear advantages regarding oncological outcomes and recurrences. However, it is a complex technique, requiring high endoscopic skills, expertise, and specialized training, with higher rates of adverse events expected compared with EMR. EMR is another endoscopic technique used to remove superficial gastrointestinal tumors, particularly those that are limited to the mucosal layer. It is a faster and more accessible procedure, with fewer adverse events, although it only allows for an en-bloc resection of lesions measuring 15-20 mm. TAMIS is a minimally invasive surgical technique used to remove rectal tumors, involving the insertion of a single-port device through the anus, allowing for a better visualization and removal of the tumor with minimal disruption. This article reviews the current applications and evidence regarding these techniques, in search for the most adequate treatment for the removal of lesions in the rectum and anorectal junction, as these locations possess distinct characteristics that demand a more specific approach.

Keywords: anorectal junction; endoscopic mucosal resection; endoscopic submucosal dissection; laterally spreading tumors; rectal adenoma; rectal cancer; rectal polyps; transanal minimally invasive surgery.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Paris classification of type 0 lesions [23]. Figure adapted from UEG Image Hub.
Figure 2
Figure 2
Subtypes of laterally spreading tumors. Models of granular and non-granular LSTs of neoplastic lesions (with flat-elevated and pseudo-depressed subtypes in non-granular lesions, and homogeneous and mixed-nodular subtypes in granular lesions), with corresponding classifications according to the categories of the Paris classification.
Figure 3
Figure 3
Rectal endoscopic mucosal resection (EMR). (A) Rectal LST-G with 30 mm. (B) Injection of saline–epinephrine and methylene blue for submucosal lifting. (C,D) Post-piecemeal mucosal resection with a snare.
Figure 4
Figure 4
Endoscopic submucosal dissection. (A) Rectal LST (NICE 2, JNET 2B, Kudo Vi) with a central depression of 25 mm. (B) Central depression via NBI. (C,D) Lesion site after ESD in retroflexed position and frontal view.
Figure 5
Figure 5
Intra-operative view of TAMIS during local excision of a distal tumor. (A) Glove port; (B) Lesion pre incision; (C,D) Dissection of the lesion.
See this image and copyright information in PMC

References

    1. Arnold M., Sierra M.S., Laversanne M., Soerjomataram I., Jemal A., Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66:683–691. doi: 10.1136/gutjnl-2015-310912. - DOI - PubMed
    1. Cronin O., Sidhu M., Shahidi N., Gupta S., O’Sullivan T., Whitfield A., Wang H., Kumar P., Hourigan L.F., Byth K., et al. Comparison of the morphology and histopathology of large nonpedunculated colorectal polyps in the rectum and colon: Implications for endoscopic treatment. Gastrointest. Endosc. 2022;96:118–124. doi: 10.1016/j.gie.2022.02.022. - DOI - PubMed
    1. D’Amico F., Amato A., Iannone A., Trovato C., Romana C., Angeletti S., Maselli R., Radaelli F., Fiori G., Viale E., et al. Risk of Covert Submucosal Cancer in Patients With Granular Mixed Laterally Spreading Tumors. Clin. Gastroenterol. Hepatol. 2021;19:1395–1401. doi: 10.1016/j.cgh.2020.07.024. - DOI - PubMed
    1. Holt B.A., Bassan M.S., Sexton A., Williams S.J., Bourke M.J. Advanced mucosal neoplasia of the anorectal junction: Endoscopic resection technique and outcomes (with videos) Gastrointest. Endosc. 2014;79:119–126. doi: 10.1016/j.gie.2013.07.003. - DOI - PubMed
    1. Carvalho B., Sillars-Hardebol A.H., Postma C., Mongera S., Terhaar Sive Droste J., Obulkasim A., van de Wiel M., van Criekinge W., Ylstra B., Fijneman R.J., et al. Colorectal adenoma to carcinoma progression is accompanied by changes in gene expression associated with ageing, chromosomal instability, and fatty acid metabolism. Cell. Oncol. 2012;35:53–63. doi: 10.1007/s13402-011-0065-1. - DOI - PMC - PubMed