Endoscopic submucosal dissection involving the anal canal presents a risk factor for postoperative stricture

Area of Science:

• Gastroenterology
• Surgical Oncology
• Colorectal Surgery

Background:

• Postoperative strictures after endoscopic submucosal dissection (ESD) for rectal lesions are uncommon.
• Resections involving the anal canal, a narrow squamous epithelium tract, may pose unique risks for stricture development.
• Limited research exists on stricture development specifically related to ESD involving the anal canal.

Purpose of the Study:

• To evaluate the impact of rectal endoscopic submucosal dissection (ESD) involving the anal canal on postoperative stricture development.
• To identify risk factors for post-ESD strictures in the rectum and anal canal.
• To compare the characteristics and management of anal versus rectal strictures.

Main Methods:

• Retrospective analysis of 707 rectal lesions treated with ESD between April 2005 and October 2017.
• Focus on 102 lesions requiring ≥75% circumferential resection.
• Investigation of risk factors for stricture, obstructive symptoms, and dilation therapy requirements.

Main Results:

• Post-ESD stricture occurred in 17.6% of patients (18/102).
• Significant risk factors for stricture included ≥90% circumferential resection and ESD involving the anal canal (ESD-IAC).
• Anal strictures were associated with higher rates of obstructive symptoms (100% vs. 27.2%) and required more dilation therapies (6.5 vs. 2.7 times) compared to rectal strictures.

Conclusions:

• Circumferential resection ≥90% and ESD-IAC are significant risk factors for rectal strictures.
• Anal strictures post-ESD present with more obstructive symptoms and necessitate more dilation therapies.
• These findings highlight the increased risk and management challenges associated with ESD involving the anal canal.