title: Feasibility and safety of endoscopic submucosal dissection for lower rectal tumors with hemorrhoids.
abstract: OBJECTIVE
  To evaluate the feasibility and safety of endoscopic submucosal dissection (ESD) for lower rectal lesions with hemorrhoids.
  
  
  METHODS
  The outcome of ESD for 23 lesions with hemorrhoids (hemorrhoid group) was compared with that of 48 lesions without hemorrhoids extending to the dentate line (non-hemorrhoid group) during the same study period.
  
  
  RESULTS
  Median operation times (ranges) in the hemorrhoid and non-hemorrhoid groups were 121 (51-390) and 130 (28-540) min. The en bloc resection rate and the curative resection rate in the hemorrhoid group were 96% and 83%, and they were 100% and 90% in the non-hemorrhoid group, respectively. In terms of adverse events, perforation and postoperative bleeding did not occur in both groups. In terms of the clinical course of hemorrhoids after ESD, the rate of complete recovery of hemorrhoids after ESD in lesions with resection of more than 90% was significantly higher than that in lesions with resection of less than 90%.
  
  
  CONCLUSIONS
  ESD on lower rectal lesions with hemorrhoids could be performed safely, similarly to that on rectal lesions extending to the dentate line without hemorrhoids. In addition, all hemorrhoids after ESD improved to various degrees, depending on the resection range.
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Eiji Umegaki, Department of Endoscopy, Kobe University Hospital, Kobe, Hyogo 650-0017, Japan.
authors.forename: Shinwa
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Eiji Umegaki, Department of Endoscopy, Kobe University Hospital, Kobe, Hyogo 650-0017, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Toyonaga
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Eiji Umegaki, Department of Endoscopy, Kobe University Hospital, Kobe, Hyogo 650-0017, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Morita
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Eiji Umegaki, Department of Endoscopy, Kobe University Hospital, Kobe, Hyogo 650-0017, Japan.
authors.forename: Namiko
authors.initials: N
authors.lastname: Hoshi
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Eiji Umegaki, Department of Endoscopy, Kobe University Hospital, Kobe, Hyogo 650-0017, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ishida
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Eiji Umegaki, Department of Endoscopy, Kobe University Hospital, Kobe, Hyogo 650-0017, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Ohara
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Eiji Umegaki, Department of Endoscopy, Kobe University Hospital, Kobe, Hyogo 650-0017, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yoshizaki
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Eiji Umegaki, Department of Endoscopy, Kobe University Hospital, Kobe, Hyogo 650-0017, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Kawara
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Eiji Umegaki, Department of Endoscopy, Kobe University Hospital, Kobe, Hyogo 650-0017, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Umegaki
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Eiji Umegaki, Department of Endoscopy, Kobe University Hospital, Kobe, Hyogo 650-0017, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006484:Hemorrhoids / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D012004:Rectal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D047368:Tumor Burden
keywords: Bleeding; Endoscopic submucosal dissection; Hemorrhoid; Outcome; Rectum