Efficacy and safety of peranal endoscopic myectomy for lower rectal lesions

Background: Peranal endoscopic myectomy (PAEM), which is a technique for removing lesions together with the inner circular muscle, has been reported as a treatment for lower rectal lesions. This study aimed to evaluate the efficacy and safety of PAEM performed at out institution.
Methods: The patients who under went PAEM for lower rectal lesions at our institution between January 2019 and December 2024 were included in this retrospective study. En bloc resection rate, procedure time, resection wound closure, histological examinations of the resected lesions, hospitalization period, and adverse events up to 28 days after treatment were evaluated.
Results: PAEM was performed in 25 cases (21 initial treatments and 4 salvage treatments for suspected residual lesions after endoscopic resection). The median age was 66 years (range, 38-89 years), and 13 case were female. En bloc resection was achieved in all cases, and the median procedure time was 72 minutes (range, 32-372 minutes). Resection wounds were closured for 13 cases. Histological examinations revealed 19 adenocarcinoma (pTis, 3; pT1, 11; pT2, 5) and 6 other lesions. Proportions of negative vertical margin were 64% (7/11) for pT1 cancers and 0% (0/5) for pT2 cancers. The median postoperative hospitalization periods was 4 days (range, 4-7 days). No cases of delayed bleeding requiring hemostatic intervention or delayed perforation were observed.
Conclusion: PAEM has been performed without severe adverse events.