{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T03:03:14Z","timestamp":1791342194084,"version":"4.3.1"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Endoscopic submucosal dissection (ESD) of rectal tumors involving the dentate line (RT-DL) is challenging because of the anatomical features of the anal canal. This study aimed to identify optimal techniques and sedation and to determine the clinical outcomes of ESD for RT-DL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively collected medical records and endoscopic results of patients who underwent ESD for rectal tumors between January 2012 and April 2021. Patients were divided into RT-DL and rectal tumors not involving the dentate line (RT-NDL) groups, as per involvement of the dentate line. The treatment results and clinical outcomes of the two groups were evaluated and analyzed. Additionally, subgroup analysis was performed in the RT-DL group for the sedation method involved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In total, 225 patients were enrolled and 22 were assigned to the RT-DL group. The complete resection rate (90.9% vs. 95.6%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.336), delayed bleeding (13.6% vs. 5.9%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.084), perforation (0% vs. 3.9%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.343), hospital stays (4.55 vs. 4.48 days,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.869), and recurrence (0% vs. 0.5%) showed no significant group differences. However, in RT-DL group, the procedure time (78.32 vs. 51.10 min,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002) was longer and there was more perianal pain (22.7% vs. 0%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001). The subgroup analysis revealed that deep sedation using propofol reduced perianal pain during the procedure (0\/14 vs. 5\/8,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>ESD of RT-DL is a safe and effective treatment despite the challenges of requiring a high level of technique and longer procedure time. In particular, ESD under deep sedation should be considered in patients with RT-DL to control perianal pain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/sjg.sjg_67_23","type":"journal-article","created":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T04:02:16Z","timestamp":1684814536000},"page":"365-370","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["Technique, sedation, and clinical outcome of endoscopic submucosal dissection for rectal tumor with involvement of dentate line: A retrospective cohort study"],"prefix":"10.4103","volume":"29","author":[{"given":"Yoon Kyoo","family":"Noh","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong Jung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,5,22]]},"reference":[{"key":"R1-20240829","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1055\/s-0034-1392882","article-title":"Endoscopic submucosal dissection:European society of gastrointestinal endoscopy (ESGE) guideline","volume":"47","author":"Pimentel-Nunes","year":"2015","journal-title":"Endoscopy"},{"key":"R2-20240829","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1016\/j.gie.2014.12.010","article-title":"Endoscopic submucosal dissection","volume":"81","author":"Committee","year":"2015","journal-title":"Gastrointest Endosc"},{"key":"R3-20240829","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1111\/den.13545","article-title":"Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection\/endoscopic mucosal resection","volume":"32","author":"Tanaka","year":"2020","journal-title":"Dig Endosc"},{"key":"R4-20240829","doi-asserted-by":"crossref","first-page":"281","DOI":"10.5217\/ir.2021.00169","article-title":"Endoscopic diagnosis and treatment of early colorectal cancer","volume":"20","author":"Hong","year":"2022","journal-title":"Intest Res"},{"key":"R5-20240829","doi-asserted-by":"crossref","first-page":"59","DOI":"10.3393\/ac.2017.12.15","article-title":"Essential anatomy of the anorectum for colorectal surgeons focused on the gross anatomy and histologic findings","volume":"34","author":"Lee","year":"2018","journal-title":"Ann Coloproctol"},{"key":"R6-20240829","first-page":"1037","article-title":"Endoscopic submucosal dissection for colorectal tumors in the dentate line area and those adjacent to the dentate line","volume":"2","author":"Matsumoto","year":"2015","journal-title":"Austin J Gastroenterol"},{"key":"R7-20240829","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/1751-2980.12701","article-title":"Clinical outcomes of endoscopic submucosal dissection for laterally spreading tumors involving the dentate line","volume":"20","author":"Guo","year":"2019","journal-title":"J Dig Dis"},{"key":"R8-20240829","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.gie.2012.04.004","article-title":"Clinical outcomes of endoscopic submucosal dissection for rectal tumor close to the dentate line","volume":"76","author":"Nakadoi","year":"2012","journal-title":"Gastrointest Endosc"},{"key":"R9-20240829","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1111\/his.13975","article-title":"WHO Classification of Tumours Editorial Board. 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