Novel approaches to minimize intraoperative bleeding during endoscopic submucosal dissection of a large rectal lateral spreading tumor extended to the dentate line with internal hemorrhoids

Abstract

Endoscopic treatment of rectal lateral spreading tumors (LSTs) extending to the dentate line with hemorrhoids is a challenging procedure because of the risk of bleeding and the reduced visual field caused by the dilated venous packages and the narrow anal lumen. Although a few Japanese reports have described the safety and efficacy of endoscopic submucosal dissection (ESD) for these tumors,1,2 technical approaches to reduce intraoperative bleeding are not fully described. We present a successful ESD of a large rectal LST that extended to the dentate line with large internal hemorrhoids and describe novel approaches to minimize intraoperative bleeding.