Endoscopic Submucosal Dissection of Lesions at the Dentate Line Compared With Rectal Lesions Above the Dentate Line
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Endoscopic Submucosal Dissection of Lesions at the Dentate Line Compared With Rectal Lesions Above the Dentate Line

Douglas K. Rex, MD, MASGE, reviewing Zeng QS, et al. J Clin Gastroenterol 2022 Apr 7.

This systematic review and meta-analysis sought to quantify the differences in outcomes after endoscopic submucosal dissection (ESD) of rectal lesions at the dentate line versus those above the dentate line. 

The authors identified 6 studies that included 265 cases at the dentate line and 788 above. The en bloc resection rate was comparable for the 2 groups of lesions, but the complete resection rate was 41% lower for dentate-line lesions. The curative resection rate (superficial submucosal invasion or benign polyp; no lymphovascular invasion) was 43% lower for dentate-line lesions. Stricture formation and local recurrence were both 3 times higher, and postprocedure anal pain was 42 times higher for dentate-line lesions. Differences in postoperative bleeding, fever, and perforation were not significant.

Douglas K. Rex, MD, FASGE

COMMENT

Because of higher rates of cancer for laterally spreading lesions in the rectum and increased morbidity related to rectal surgical procedures, laterally spreading rectal lesions are increasingly targeted for en bloc resection. These data indicate specific challenges for lesions at the dentate line, though ESD clearly remains an appropriate treatment.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Zeng QS, Zou M, Nie J, Yang JH, Luo ZY, Gan HT. Efficacy and safety of endoscopic submucosal dissection for rectal tumors extending versus not to the dentate line: a systematic review and meta-analysis. J Clin Gastroenterol 2022 Apr 7. (Epub ahead of print) (https://doi.org/10.1097/mcg.0000000000001692)

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