Endoscopic organ-preserving interventions for large epithelial rectal neoplasms (a multicenter study)

Large benign rectal neoplasms present a significant clinical challenge, as traditional surgical interventions frequently lead to disabling outcomes and a marked reduction in quality of life. Endoscopic submucosal dissection (ESD) is an organ-preserving alternative; however, evidence regarding its use for large and subcircumferential rectal lesions remains limited. Objective. To evaluate the effectiveness and safety of ESD for the removal of large rectal neoplasms (>20 cm²). Materials and Methods. This multicenter study included 80 patients treated between 2018 and 2024. The cohort comprised 37 men and 43 women, with a mean age of 80 years (range 38—90). All patients had benign rectal adenomas exceeding 20 cm² in surface area. Technical success, complication rates, and follow-up outcomes were assessed. Results. En-bloc resection was achieved in 76 patients (95%), while 4 cases (5%) required a hybrid technique using an endoscopic snare. Postoperative bleeding occurred in 6 patients (7.5%) and was successfully managed endoscopically. Superficial muscle layer injury was identified in 27 patients (33.7%) and did not require intervention. Full-thickness defects were noted in 2 patients (2.5%) and were closed using OTSC or standard clips. At the 3-month follow-up, clinically insignificant scar changes without stenosis were observed in 68 patients (85%); 5 patients (6.25%) with circumferential lesions had mild luminal narrowing without functional impairment. Conclusion. ESD is an effective and safe organ-preserving method for removing large benign rectal neoplasms, including lesions located close to the anal canal. This technique helps avoid stoma-forming radical surgery and minimizes the risk of delayed cicatricial strictures when postoperative management protocols are followed.