Introduction Current trans-anal surgical and advanced endoscopic resection procedures have the potential to resect complex rectal polyps (CRPs). However both approaches have limitations in terms of practicality and safety.
Methods Consecutive patients (Jan13/April15), referred for the excision of CRPs, were being considered for proctectomy and/or had failed conventional endoscopic/trans-anal therapy. The GelPoint Path trans-anal access port allowed dynamic tissue manipulation to facilitate endoscopic-submucosal-dissection/ESD. Supplementary techniques were also used: piecemeal-endoscopic-mucosal-resection or ablation/P-EMR or EMA and trans-anal excision/TAE. The aim of this study was to evaluate the feasibility, technical success and safety profile of this new hybrid, endo-surgical Trans-Anal Submucosal Endoscopic Resection- (TASER) approach for CRPs.
Results Thirty-two TASER procedures were employed in 31 patients (mean age 65 years/17 males-14 females) with 31 CRPs (mean size 8 cm/range 5 cm–18 cm). Complete endoscopic excision in a single session was achieved in 28/31 patients (93%); in one patient a second TASER session for completion of polypectomy, in another an elective laparoscopic-anterior-resection due to T1,sm3,N0,M0 and in a third patient a defunctioning-ileostomy due to intraperitoneal perforation before completion of polypectomy. Mean procedure time was 185 min, range 65–480 min. Thirty two TASER sessions were employed using ESD in 12/32, ESD+P-EMR in 6/32, ESD+P-EMR+EMA in 4/32, ESD+TAE in 3/32, ESD/P-EMR/TAE in 3/32 and ESD+P-EMR+EMA+TAE in 4/32. Intra-procedural bleeding was controlled with haemostatic endoscopic devices/surgical clipping. In 6/10 TASER-TAE cases there was a need for a full-thickness rectal dissection due to severe submucosal fibrosis: 4/6 cases were closed with surgical sutures/endoscopic clips and in 2/6 cases only endoscopic clips were deployed. Two episodes of delayed bleeding were reported with no transfusion/re-intervention requirement. All patients were discharged the day after the TASER apart from one patient who developed bacteremia requiring intravenous antibiotics/a 4 night hospital stay and the patient who required a defunctioning ileostomy, discharged on day 4 post-operation. First follow-up performed at 4–6 months interval in 25/31 patients showed: 21/25 with no recurrence/(84%) and 4/25/ (16%) with a minimal (<15mm) polyp recurrence, amenable to endoscopic therapy. No rectal stricturing was identified and only one episode of transient faecal incontinence were reported.
Conclusion TASER appears to be a safe and efficient endo-surgical approach providing an optimal platform for the minimally-invasive management of high- risk, complex rectal polyps.
Disclosure of Interest None Declared