Clinical Characteristics Analysis of Anorectal Function Changes After Endoscopic Submucosal Dissection for Rectal Lesions.

Abstract

Background and aims: Although endoscopic submucosal dissection (ESD) are established for rectal neoplasms, postprocedural anorectal dysfunction (e.g., altered bowel habits, urgency, or anal discomfort) remains poorly characterized. This study aimed to determine the incidence, risk factors, and temporal recovery patterns of these symptoms.

Methods: A retrospective analysis was conducted of 296 patients who underwent ESD for rectal lesions from January 2020 to December 2023. Data regarding the ESD procedure and anorectal symptoms were collected, including scores from the Low Anterior Resection Syndrome (LARS), Wexner Fecal Incontinence Scale, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Gastrointestinal Quality of Life Index (GIQLI) at 1 week, 3 months, 6 months, and 12 months postoperatively. Patients were categorized into symptomatic and asymptomatic groups, and a comparative analysis of clinical features was conducted.

Results: Out of 296 patients, 82 (27.7%) experienced anorectal symptoms, primarily characterized by increased bowel movements, anal discomfort, defecation urgency, and loose stools. The LARS, Wexner, SAS, and SDS scores showed a decreasing trend during the 1-week to 12-month postoperative period, while the GIQLI score exhibited an increasing trend. Compared to the asymptomatic group, the symptomatic group had significantly higher LARS, Wexner, SAS, and SDS scores and a lower GIQLI score at 1 week and 3 months postoperatively (P < 0.05). NO significant differences in SAS, SDS, and GIQLI scores were observed between the two groups at 6 months and 12 months postoperatively (P > 0.05). Multivariate logistic regression identified lesion location and size as significant predictors.Compared with patients with lesions ≤5 cm from the anal verge, those with lesions 5-10 cm and >10 cm from the anal verge had significantly reduced risks of postoperative symptoms (OR = 0.202, P < 0.001; OR = 0.100, P < 0.001). Lesions >4 cm from the anal verge were significantly associated with an increased risk of postoperative symptoms (OR = 7.259, P = 0.003).

Conclusion: The occurrence of anorectal symptoms following rectal ESD is closely related to the location and size of the lesion. The psychological and quality-of-life impairments caused by these symptoms are primarily short-term and can gradually recover over time.