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19-03-2013 | Surgery | Article

Rarely used endoscopic technique ‘fills niche’ in rectal adenoma treatment


Free abstract

medwireNews: Endoscopic transanal resection (ETAR) is effective for the removal of rectal adenomas, say the authors of a 15-year study of the technique.

Ville Sallinen (South Karelia Central Hospital, Lappeenranta, Finland) and colleagues found that the scarcely used method resulted in a 15% adenoma recurrence rate and a cancer incidence rate of 3% over a mean follow-up of 30 months.

The study included 92 patients who underwent surgery between 1996 and 2010, 30% of whom had ETAR for recurrent adenoma. The majority (72%) of polyps were sessile.

The complication rate was 15%, with only one major complication of suspected intraperitoneal perforation. There were no perioperative mortalities or conversions to open procedures, and the mean hospital stay was 4.4 days, with the majority of patients leaving on the first postoperative day.

Notably, the mean patient age was 71 years, and the median American Society of Anesthesiologists score was 3, indicating that the technique is suitable for those with significant comorbidities, including the old and frail, Sallinen and colleagues say.

The technique provides an alternative to other transanal techniques such as piecemeal endoscopic mucosal resection and transanal endoscopic microsurgery, the latter of which is associated with high technical complexity and costs.

Conversely, say the authors, ETAR offers a low-cost, easy-to-learn technique, particularly when colorectal surgeons are accompanied by their more experienced urology colleagues.

"ETAR is an inexpensive option because most hospitals already have the equipment needed (i.e., urologic resectoscope)," they write. "This is especially important in developing countries with lower resources."

However, Sallinen et al caution against its use for T1 rectal cancers, which some surgeons have previously suggested, due to incomplete resection margins.

"ETAR has a niche in the armamentarium of treating rectal adenomas," the authors write in Surgical Endoscopy.

"It is a minimally invasive, inexpensive, safe, and a relatively easy method for treating rectal adenomas not amenable to polypectomy or for patients who are not fit enough for major surgical resection," they conclude.

By Kirsty Oswald, medwireNews Reporter

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