title: The effect of endoscopic mucosal resection and transanal endoscopic microsurgery on anorectal function.
abstract: OBJECTIVE
  The study assessed the impact on anorectal function of endoscopic mucosal resection (EMR) and transanal endoscopic microsurgery (TEM) of large rectal adenomas.
  
  
  METHODS
  Patients with a large (≥ 3 cm) rectal adenoma undergoing EMR or TEM were included. Self-reported faecal incontinence was assessed using the Colorectal Functional Outcome (COREFO) questionnaire and the Wexner Incontinence Grading Scale. Anorectal manometry was performed before and at 6 months after treatment to measure anal resting (ARP) and squeeze pressure (SP), squeeze endurance (SE), the rectoanal inhibitory reflex (RAIR), rectal volumetry of first sensation (FS), first urge (FU), maximum tolerable volume (MTV) and rectal compliance (RC).
  
  
  RESULTS
  Twenty-four patients were included in the study, of whom 11 underwent EMR and 13 underwent TEM. The mean adenoma size was 51 ± 19 mm and the median distance from the anal verge was 3 cm (interquartile range 1-10 cm). Follow-up data were available from 20 patients; one patient had died and three had undergone total mesorectal excision. Incontinence for liquid stool and Wexner score decreased significantly after treatment. In contrast, none of the measured parameters of anorectal motility (ARP, SP, SE, RAIR, RC) and perception (FS, FU, MTV) was affected by adenoma resection. No differences were found in baseline and follow-up incontinence and functional parameters between intervention groups, except for postprocedural ARP, which was lower after TEM than after EMR.
  
  
  CONCLUSIONS
  Continence in patients with a large rectal adenoma improved after EMR or TEM, probably due to decreased rectal mucus production. Anal sphincter pressure, rectoanal reflexes, rectal sensation and compliance were not affected by adenoma resection.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: R M
authors.initials: RM
authors.lastname: Barendse
authors.forename: J M
authors.initials: JM
authors.lastname: Oors
authors.forename: E J R
authors.initials: EJ
authors.lastname: de Graaf
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
authors.forename: P
authors.initials: P
authors.lastname: Fockens
authors.forename: E
authors.initials: E
authors.lastname: Dekker
authors.forename: A J P M
authors.initials: AJ
authors.lastname: Smout
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000236:Adenoma / Q000601:surgery*; D000368:Aged; D001003:Anal Canal / Q000293:injuries / Q000503:physiopathology*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008365:Manometry; D008866:Microsurgery / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D011312:Pressure; D011351:Proctoscopy / Q000009:adverse effects / Q000379:methods; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000293:injuries / Q000503:physiopathology*; D016896:Treatment Outcome
keywords: Anorectal function; adenoma; endoscopic mucosal resection; rectum; transanal endoscopic microsurgery