Background and Aims
The incidence of rectal neuroendocrine tumors (NETs) is increasing, and most small
rectal NETs can be treated endoscopically. Cap-assisted EMR (EMR-C) was suggested
as an effective treatment for rectal NETs in a few studies. We aimed to compare the
outcomes of conventional EMR, EMR-C, and endoscopic submucosal dissection (ESD) for
the treatment of rectal NETs.
Methods
A total of 138 rectal NETs were treated endoscopically by a single endoscopist at
Asan Medical Center. We analyzed 122 rectal NETs that had been removed by using EMR
(n = 56), EMR-C (n = 34), or ESD (n = 32).
Results
The histologic complete resection rate was higher in the EMR-C group than in the EMR
group (94.1% vs 76.8%, P = .032). Intraprocedural bleeding tended to be more frequent in the EMR-C group than
in the EMR group (8.8% vs 0%, P = .051). No differences in the rates of adverse events or histologic complete resections
were observed between the EMR-C group and the ESD group for 6-mm to 8-mm NETs; however,
the procedure time was significantly shorter in the EMR-C group (3.9 ± 1.1 minutes)
than in the ESD group (19.0 ± 12.1 minutes) (P < .001). There was no recurrence in any of the 3 groups.
Conclusions
EMR-C is the preferable technique for endoscopic resection of small rectal NETs.
Abbreviations:
EMR-C (cap-assisted EMR), ESD (endoscopic submucosal dissection), NET (neuroendocrine tumor)To read this article in full you will need to make a payment
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References
- The epidemiology of neuroendocrine tumors in Taiwan: a nation-wide cancer registry-based study.PLoS One. 2013; 8: e62487
- Carcinoid tumors of the gastrointestinal tract: trends in incidence in England since 1971.Am J Gastroenterol. 2010; 105: 2563-2569
- The epidemiology of gastroenteropancreatic neuroendocrine tumors.Endocrinol Metab Clin North Am. 2011; 40 (vii): 1-18
- Current Trends of the Incidence and Pathological Diagnosis of Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs) in Korea 2000-2009: Multicenter Study.Cancer Res Treat. 2012; 44: 157-165
- Updating the management of patients with rectal neuroendocrine tumors.Endoscopy. 2013; 45: 1039-1046
- Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread.Endoscopy. 2011; 43: 790-795
- Endoscopic submucosal dissection for treatment of rectal carcinoid tumors.Gastrointest Endosc. 2010; 72: 143-149
- Rectal carcinoid tumors: review of results after endoscopic and surgical therapy.Arch Surg. 2008; 143: 471-475
- Carcinoids of the rectum: an evaluation of 1271 reported cases.Surg Today. 1997; 27: 112-119
- Endoscopic submucosal resection with a ligation device is an effective and safe treatment for carcinoid tumors in the lower rectum.J Gastroenterol Hepatol. 2008; 23: 218-221
- Efficacy of endoscopic submucosal resection with a ligation device for removing small rectal carcinoid tumor compared with endoscopic mucosal resection: analysis of 100 cases.Dig Endosc. 2012; 24: 159-163
- A comparative study on endoscopy treatment in rectal carcinoid tumors.Surg Laparosc Endosc Percutan Tech. 2012; 22: 260-263
- Saline-assisted endoscopic resection of rectal carcinoids: cap aspiration method versus simple snare resection.Endoscopy. 2004; 36: 202-205
- Endoscopic resection of rectal carcinoid tumors using aspiration lumpectomy.Endoscopy. 1997; 29: 34-38
- Endoscopic submucosal dissection for the treatment of rectal carcinoid tumors 7-16 mm in diameter.Int J Colorectal Dis. 2015; 30: 375-380
- Atypical endoscopic features of rectal carcinoids.Endoscopy. 2004; 36: 313-316
- Endoscopic submucosal dissection with or without snaring for colorectal neoplasms.Gastrointest Endosc. 2011; 74: 1075-1083
Yang DH, Jeong GH, Song Y, et al. The feasibility of performing colorectal endoscopic submucosal dissection without previous experience in performing gastric endoscopic submucosal dissection. Dig Dis Sci. Epub 2015 Jun 19.
- Korean guidelines for postpolypectomy colonoscopy surveillance.Clin Endosc. 2012; 45: 44-61
- Histologic correlates of gastrointestinal ultrasound images.Gastroenterology. 1989; 96: 433-441
- Evaluation of the colorectal wall in normal subjects and patients with ulcerative colitis using an ultrasonic catheter probe.Gastrointest Endosc. 1998; 48: 477-484
- Individual variations in mucosa and total wall thickness in the stomach and rectum assessed via endoscopic ultrasound.Physiol Meas. 2003; 24: N15-22
- Accuracy of endoscopic ultrasound to diagnose nodal invasion by rectal cancers: a meta-analysis and systematic review.Ann Surg Oncol. 2009; 16: 1255-1265
- Clinical outcomes of rectal neuroendocrine tumors </= 10 mm following endoscopic resection.Endoscopy. 2013; 45: 1018-1023
- Rectal carcinoid tumor: a delayed localized recurrence 23 years after endoscopic resection.Endoscopy. 2014; 46: E555-E556
- Natural course of an untreated metastatic perirectal lymph node after the endoscopic resection of a rectal neuroendocrine tumor.Intest Res. 2015; 13: 175-179
Article info
Publication history
Published online: October 09, 2015
Accepted:
September 8,
2015
Received:
April 18,
2015
Footnotes
Disclosure: All authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2015 American Society for Gastrointestinal Endoscopy.
