Abstract
BACKGROUND: Improvement in internal hemorrhoids is frequently observed after endoscopic submucosal dissection (ESD) for rectal intraepithelial neoplasia. This study investigated the effectiveness of rectal ESD in the management of internal hemorrhoids. OBJECTIVES: Twenty-three patients who underwent ESD for tumors adjacent to the dentate line and associated with internal hemorrhoids. DESIGN: A single-arm, retrospective multi-center study. METHODS: The focal improvement (at the scarring area after ESD) and complete improvement rates of hemorrhoids at follow-up colonoscopies were evaluated. RESULTS: Most patients (87%) had mild hemorrhoids. The focal and complete improvement rates of hemorrhoids were 83% and 48%, respectively. Complete improvement rates were 75% (3/4), 42% (5/12), and 43% (3/7) for tumors involving ⩾1/2, between 1/4 and 1/2, and <1/4 of the circumference at the dentate line, respectively. No recurrence was observed after initial improvement, with a median observation period of 35 months. CONCLUSION: ESD may be an effective treatment for internal hemorrhoids.