Endoscopic submucosal dissection safe, effective for RNDLs

A recent study has shown the safety and efficacy of endoscopic submucosal dissection (ESD) in the management of rectal neoplasms extending to the dentate line (RNDLs), which also boasts of a low recurrence rate.

The investigators conducted a comprehensive electronic database search from January 2005 through January 2024 for studies that assessed ESD outcomes in patients with RNDLs. They calculated pooled proportions using random-effect models and evaluated heterogeneity using I² and Q statistics.

Eleven studies met the eligibility criteria and provided data for 496 patients. The pooled en bloc resection rates were 93.60 percent (95 percent confidence interval [CI], 90.70–95.70), while the pooled R0 resection rate was 80.60 percent (95 percent CI, 70.50–87.80).

Recurrence was low, with a pooled rate of just 4.00 percent (95 percent CI, 2.40–6.50). No evidence of significant heterogeneity was found.

In terms of safety, the most common adverse events were anal pain (20.20 percent, 95 percent CI, 14.80–26.90), postprocedural bleeding (8.20 percent, 95 percent CI, 4.70–14.0), and anal stricture (3.50 percent, 95 percent CI, 2.10–5.70).

“Adverse events such as postprocedural perianal pain, postprocedural bleeding, and anal stenosis seem to be more common compared with colorectal ESD done for more proximal lesions,” the investigators said. “However, these can typically be managed conservatively or with minimally invasive endoscopic techniques.”