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Choosing the best approach for laterally spreading lesions at the anorectal junction
  1. João Santos-Antunes1,2,
  2. Margarida Marques1,
  3. Fátima Carneiro2,3,
  4. Guilherme Macedo1
  1. 1 Gastroenterology Department, Centro Hospitalar S João, Faculty of Medicine, Porto, Portugal
  2. 2 IPATIMUP/ i3S, Porto, Portugal
  3. 3 Pathology Department, Centro Hospitalar S João, Faculty of Medicine, Porto, Portugal
  1. Correspondence to Dr João Santos-Antunes, Gastroenterology Department, Centro Hospitalar de São João, Faculty of Medicine, Porto, Portugal; joao.claudio.antunes{at}

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We read with great interest the paper by Shahidi N et al concerning the resection of rectal lesions, particularly those in the anorectal junction, by endoscopic mucosal resection (EMR).1 They found that EMR is effective, with good safety and recurrence outcomes.

Our Department has a large experience in both EMR and endoscopic submucosal dissection (ESD).2 Most of the colonic lesions are removed by EMR, with the exception of those with high-risk features, that are removed by ESD. By contrast, we remove all the rectal lesions by ESD. This approach is based on our large experience in ESD (nearly 550 procedures), the very good outcome and safety profiles, the endoscopic accessibility of these lesions compared with those located in the colon and the aggressive complementary treatment that could be required after a piecemeal resection of a malignant lesion. In …

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  • Contributors JS-A performed endoscopic submucosal dissection (ESD) procedures, gathered data, analysed data and wrote the manuscript. MM performed ESD procedures and reviewed the manuscript. FC is responsible for the analysis of the ESD specimens. GM reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.