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 effi cacy of endoscopic submucosal dissection (ESD) for these tumors,1,2 technical approaches to reduce intraoper ative 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.