Tips for Post-EMR Bleeding for Lesions Located at the Anal Verge or Distal Rectum

This polyp is located on the anal verge, right proximal to the dentate line. What would you do?

A. Endoscopic band ligation

B. Refer to colorectal surgeon or proctologist

C. Resect using regular snare

D. Resect using EMR technique

E. Other


Polyps or polypoid lesions located close to the dentate line may represent a challenge for endoscopic resection. However, careful delineation and injection of submucosal cushion can lead to safe and effective endoscopic resection. Tips for post-EMR bleeding for lesions located at the anal verge or distal rectum: a) you can tamponade using your finger, b) other measures such as oxidized cellulose (or toilet paper = cellulose) also are effective for hemostasis. If you use clips always look at the dentate line, which must be avoided as it has a very rich nerve ending and clipping there will lead to lots of pain.