Feasibility and safety of endoscopic submucosal dissection for the anal canal lesions

We aimed to evaluate the technical safety, efficacy, and feasibility of endoscopic submucosal dissection (ESD) for anal canal lesions (ACLs) and compare outcomes between lesions involving the dentate line (IDL) and those above the dentate line (ADL) to guide clinical decision-making.

We retrospectively investigated 102 patients with ACLs who underwent ESD from August 2010 to August 2023. We collected and analyzed clinicopathologic characteristics, procedure-related parameters, outcomes, and follow-up data.

Of the 102 patients with ACLs (mean age 63 years, 46 men), ADLs were in 55 patients, and IDLs were in 47. The mean procedure duration was 37.0 minutes. The en bloc resection and en bloc with R0 resection rates were 94.1% and 88.2%, respectively. Adverse events included 2 intraoperative bleeding, 2 delayed bleeding, and 1 episode of febrility. Anal pain occurred in 5 patients. During a median follow-up of 37 months, local recurrence was revealed in 3 patients, and 1 had metastases. Compared with the ADL group, the involving dentate line group had significantly longer procedure duration, larger specimens, lower rates of en bloc with R0 resection, greater rates of anal pain, and more adverse events. When only adenomas/adenocarcinomas were included in the analysis, the 2 groups had no significant differences regarding recurrence-free, overall, and disease-specific survival.

The favorable short- and long-term outcomes indicate ESD is a safe, effective, and attractive therapeutic modality for ACLs. A multicenter and prospective study should be conducted to validate this technology.