title: Retroflexion-assisted endoscopic mucosal resection: a useful and safe method for removal of low rectal laterally spreading tumors.
abstract: OBJECTIVE
  Lesions below or involving the dentate line cannot be removed by standard forward-viewing endoscopic mucosal resection (EMR). Data about retroflexion technique applied during EMR for low rectal laterally spreading tumors (LSTs) are quite limited. Therefore, we aimed to determine the efficacy and safety of retroflexion-assisted EMR (REMR) for the removal of large LSTs from the lower rectum.
  
  
  METHODS
  EMR employing a complete retroflexion technique was performed in 49 consecutive patients (28 men, 21 women; mean age 51.8 years) with low rectal LSTs that were considered unresectable by conventional forward-viewing EMR due to the narrow and poor endoscopic view. Colonoscopy follow-up data were collected after resection.
  
  
  RESULTS
  The low rectal LSTs had a median size of 51 mm (range 30-85 mm). All the tumors were successfully resected in two sessions (median procedure time 57.4 min, range 29-126 min). Procedure-related early bleeding occurred in 14 patients, and delayed hemorrhage occurred in four patients. Serious complications such as perforation or anal dysfunction were not observed, and any procedure-related bleeding was well controlled. The median follow-up period was 8.4 months (range 3-36 months). Nine patients (nine out of 49, 18.4%) experienced recurrence based on follow-up colonoscopy examinations, and the recurrent lesion was completely eradicated by additional endoscopic treatments.
  
  
  CONCLUSIONS
  This is the first pilot study to evaluate the efficacy and safety of REMR for removal of low rectal LSTs. The short-term outcomes observed in this study indicate that REMR is a valuable method for the removal of low rectal LSTs. However, further studies evaluating the long-term efficacy and comparing REMR with other interventional therapies are needed.
authors: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China. liuside@163.com.
authors: Side
authors: S
authors: Liu
authors: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China. liyue_1989919@126.com.
authors: Yue
authors: Y
authors: Li
authors: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
authors: Haiyun
authors: H
authors: Yang
authors: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
authors: Aimin
authors: A
authors: Li
authors: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
authors: Zelong
authors: Z
authors: Han
authors: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.|Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
authors: Xianfei
authors: X
authors: Wang
authors: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
authors: Feng
authors: F
authors: Xiong
authors: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
authors: Wen
authors: W
authors: Xu
authors: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
authors: Dan
authors: D
authors: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods*; D004598:Electrosurgery; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010865:Pilot Projects; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Efficacy; LSTs; REMR; Safety