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The effect of endoscopic mucosal resection and transanal endoscopic microsurgery on anorectal function
Author(s) -
Barendse R. M.,
Oors J. M.,
Graaf E. J. R.,
Bemelman W. A.,
Fockens P.,
Dekker E.,
Smout A. J. P. M.
Publication year - 2013
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12311
Subject(s) - medicine , anorectal manometry , anal verge , interquartile range , microsurgery , anal canal , sphincter , adenoma , surgery , rectum , defecation , colorectal cancer , cancer
Abstract Aim The study assessed the impact on anorectal function of endoscopic mucosal resection ( EMR ) and transanal endoscopic microsurgery ( TEM ) of large rectal adenomas. Method Patients with a large (≥ 3 cm) rectal adenoma undergoing EMR or TEM were included. Self‐reported faecal incontinence was assessed using the C olorectal F unctional O utcome ( COREFO ) questionnaire and the W exner I ncontinence G rading S cale. Anorectal manometry was performed before and at 6 months after treatment to measure anal resting ( ARP ) and squeeze pressure ( SP ), squeeze endurance ( SE ), the rectoanal inhibitory reflex ( RAIR ), rectal volumetry of first sensation ( FS ), first urge ( FU ), maximum tolerable volume ( MTV ) and rectal compliance ( RC ). Results Twenty‐four patients were included in the study, of whom 11 underwent EMR and 13 underwent TEM. The mean adenoma size was 51 ± 19 mm and the median distance from the anal verge was 3 cm (interquartile range 1–10 cm). Follow‐up data were available from 20 patients; one patient had died and three had undergone total mesorectal excision. Incontinence for liquid stool and W exner score decreased significantly after treatment. In contrast, none of the measured parameters of anorectal motility ( ARP , SP , SE , RAIR , RC ) and perception ( FS , FU , MTV ) was affected by adenoma resection. No differences were found in baseline and follow‐up incontinence and functional parameters between intervention groups, except for postprocedural ARP , which was lower after TEM than after EMR . Conclusion Continence in patients with a large rectal adenoma improved after EMR or TEM , probably due to decreased rectal mucus production. Anal sphincter pressure, rectoanal reflexes, rectal sensation and compliance were not affected by adenoma resection.