Endoscopic Submucosal Dissection, Endoscopic Mucosal Resection and Transanal Minimally Invasive Surgery for the management of rectal and anorectal lesions: a narrative review

Abstract

Recently, endoscopic techniques gained a crucial role in the treatment of colorectal lesions. Endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and transanal minimally invasive surgery (TAMIS) are modern techniques that have been gaining popularity. ESD is a minimally invasive endoscopic procedure that allows the resection of lesions of any size in a single piece, with clear advantages regarding oncological outcomes and recurrences. However, it´s more complex, requiring expertise and specialized training, reporting higher rates of adverse events comparing to EMR. EMR is another endoscopic technique used to remove superficial gastrointestinal tumors, particularly those that are limited to the mucosal layer. It´s a faster and more available procedure, with less adverse events, yet it only allows en bloc resection of lesions until 15-20mm. TAMIS is another minimally invasive technique used to remove rectal tumors, involving the insertion of a single-port device through the anus, allowing a better visualization and removal of the tumor with minimal disruption. This article reviews the current applications and evidence regarding these techniques, looking for the most adequate treatment for the removal of lesions in the rectum and anorectal areas, believing that these locations possess distinct characteristics that demand a more specific approach.