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Introduction Trans-Anal Submucosal Endoscopic Resection (TASER) is a novel instrumental platform for resection of large (≥5 cm) and/or complex rectal polyps (CRPs). It involves a multi-port trans-anal access, enabling dynamic tissue retraction to assist endoscopic submucosal dissection (ESD), used alone or in conjunction with supplementary techniques [Endoscopic Mucosal Resection (EMR) or Ablation (EMA), Trans-Anal Excision (TAE)]. Methods A prospective database (Jan 2013–October 2017) was analysed including consecutive patients undergoing TASER for CRPs in two UK centres. Results Sixty-four CRPs (median size 7.5 cm; range: 5–18) were resected in 64 patients (36 males, mean 67.1 years): 33 by ESD and 31 by hybrid procedures (ESD+EMR=14, ESD+EMR+EMA=6, ESD+TAE=4, ESD+EMR+TAE=3, ESD+EMR+EMA+TAE=4). Forty-seven (73.4%) lesions were granular-type laterally spreading tumors, 9 (14.1%) were recurrences, 13 (20.3%) had severe submucosal fibrosis, and 7 (10.9%) involved the dentate line. Histology showed low-grade adenoma/dysplasia in 35 (54.7%), high-grade adenoma/dysplasia in 21 (32.8%), T1 Complete endoscopic excision was achieved in a single session in 60 (93.8%), and 2 sessions in 4 (6.2%) cases. Thirty-eight (59.4%) resections were en-bloc, and 36(56.3%) were histologically complete. Delayed bleeding and post-polypectomy syndrome occurred in 3 (4.7%) and 7 (10.9%) respectively, with no surgical intervention required. One patient underwent a defunctioning ileostomy due to intra-peritoneal perforation. Of the 9 malignant cases: 4 with T1≥1000 µm cancer (2/4 full thickness) were subject to radical surgery, and 5 with T1 Conclusions The current study demonstrates favorable clinical outcomes of TASER, offering surgery-sparing cure in >90% of patients with CRPs. The use of a transanal platform to allow a flexible resection approach, enabling both endoscopic and trans-anal resection techniques, appears to be advantageous.

Introduction There is limited experience of endoscopic submucosal dissection (ESD) for resection of colorectal lesions in the West and outcome data tends to be worse than that reported from Japanese centres. We report the outcomes of ESD in a single, tertiary UK referral centre. Methods A prospective database was analysed including 165 consecutive patients (mean age: 64.6±12.6 years, 62.4% males) with 173 colorectal neoplasms resected by ESD between 3/2012 and 12/2017. Two experienced colonoscopists performed all procedures. Results The median (IQR) lesion size was 3.5 cm (2–5), and 140 (80.9%) were located in the rectum. Overall, 49.7% were granular-type laterally spreading tumours (LST), 19.7% were non-granular LST, and 30.6% were polypoid lesions. In 29 (16.7%) cases a flexible endosurgical platform was used to assist ESD of complex rectal polyps [median(IQR) size: 6 cm (5–8)] by dynamic trans-anal retraction (Trans-Anal Submucosal Endoscopic Resection; TASER). Histology showed low-grade adenoma/dysplasia in 83 (47.9%), high-grade adenoma/dysplasia in 52 (30%), T1 cancer ( Conclusions The current study demonstrates favourable clinical outcomes of selected colorectal ESD in a Western endoscopy setting. Further studies addressing the cost-effectiveness of ESD and comparing its long-term outcome with endoscopic mucosal resection in the West are needed.