GI Endoscopy · 1 min read
Tips for Post-EMR Bleeding for Lesions Located at the Anal Verge or Distal Rectum
Experienced teaching points
Clinical Pearls
- Endoscopic resection of polyps near the anal verge is safe and feasible, but precise delineation and generous submucosal injection are critical to lift the lesion away from the underlying sphincter complex.
- If post-EMR bleeding occurs at the anal verge, simple digital tamponade or the topical application of oxidized cellulose (or even toilet paper) are highly effective, non-traumatic hemostatic measures.
- When deploying hemostatic clips in the distal rectum, you must meticulously identify and avoid the dentate line; clipping this nerve-rich area will cause the patient severe, immediate pain.
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
Answer
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.
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