Feasibility and safety of endoscopic submucosal dissection for lower rectal tumors with hemorrhoids

Figure 1 Endoscopic submucosal dissection for lower rectal lesion with hemorrhoids. A: The laterally spreading tumor granular type (nodular mixed type) with hemorrhoids located in the lower rectum and expanding to half of the lumen; B: A shallow mucosal incision was performed and the vessels were exposed while inflicting as little damage as possible; C: The exposed vessels were coagulated using hemostatic forceps; D: The submucosal layer is tightly connected with submucosal muscle strands; E: Dissociation of submucosal muscle strands completely; F: The submucosal dissection was performed just above the muscularis propria layer; G: The ulcer floor after ESD; H: The resected specimen with many vessels.

Figure 2 Flow chart of patients who underwent endoscopic submucosal dissection for lower rectal lesions with hemorrhoids.

Figure 3 Endoscopic submucosal dissection for lower rectal lesions with hemorrhoids. A, B: The laterally spreading tumor granular type (nodular mixed type) with hemorrhoids located at the lower rectum expanding to half of the lumen; C: The ulcer floor after endoscopic submucosal dissection (ESD); D: Hemorrhoid was partially improved (1 year after ESD). Yellow arrow indicates remnant hemorrhoids and red arrow indicates ESD scar.

Figure 4 Endoscopic submucosal dissection for lower rectal lesions with hemorrhoids. A, B: Two 0-IIa lesions (blue arrows) located on the hemorrhoids; C: The ulcer floor after ESD; D: Complete recovery from hemorrhoids was achieved (6 mo after ESD). Red arrow indicates ESD scar.