Choosing the best approach for laterally spreading lesions at the anorectal junction

We read with great interest the paper by Shahidi N et al concerning the resection of rectal lesions, particularly those in the anorectal junction, by endoscopic mucosal resection (EMR).1 They found that EMR is effective, with good safety and recurrence outcomes. Our Department has a large experience in both EMR and endoscopic submucosal dissection (ESD).2 Most of the colonic lesions are removed by EMR, with the exception of those with high-risk features, that are removed by ESD. By contrast, we remove all the rectal lesions by ESD. This approach is based on our large experience in ESD (nearly 550 procedures), the very good outcome and safety profiles, the endoscopic accessibility of these lesions compared with those located in the colon and the aggressive complementary treatment that could be required after a piecemeal resection of a malignant lesion. In our …