[Endoscopic submucosal resection with ligation of rectal carcinoids: 3 years experience].
OBJECTIVE
To assess the value of endoscopic submucosal resection with ligation (ESMRL) in rectal carcinoids.


METHODS
45 patients with rectal carcinoids, 20 males and 25 females, aged 58 +/- 18 (19 - 73), were treated with ESMRL from April, 2002 to April, 2006. The radical resection rate, complication rate, relapse rate, and metastasis rate were analyzed.


RESULTS
Carcinoids accounted for 1.8% of the 24,600 cases undergoing colonoscopy at the same time. All the carcinoids were located 2 - 15 cm from anal border, with a mean diameter of (1.4 +/- 0.3) cm (0.3 - 2.0 cm). The endoscopic ultrasonographic (EUS) characteristic was a hypoechoic solid tumor in the superficial submucosa (24 cases, 53%) or in both the mucosa and submucosa (21 cases, 47%) without involvement of the muscularis propria. All patients received ESMRL of the rectal carcinoids, of which 34 cases (75.6%) needed more hemostasis of the incision margin. The mean operation time was (25 +/- 4) min. 7 cases (15.6%) with tardy bleeding 2 - 7 days after ESMRL needed endoscopic re-hemostasis, of which 3 cases (43%) showed oozing of blood from the muscle layer and another 4 showed oozing of blood or arterial bleeding from the incision border. No perforation or inflammatory was reported. 39 cases (86.7%) had negative margin in pathological examination, and the incision margins of the other 6 patients, as normal submucosal layer could not be seen outside the tumor envelope, could not be evaluated. But the tumor envelope was integrated without involvement of tumor and other biopsy results 7 days after ESMRL was negative. So no more therapies were selected. All 45 patients were followed up for 31 months (6 - 52 months), there was no metastasis, relapse and dead cases.


CONCLUSIONS
ESMRL is an effective, safe, and minimally invasive method to deal with rectal carcinoids.
Zhong
Yun-Shi
YS
Department of Surgery, Shanghai Medical College, Fudan University; Endoscopic Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhou
Ping-Hong
PH
Xu
Mei-Dong
MD
Zhang
Yi-Qun
YQ
Chen
Wei-Feng
WF
Ma
Li-Li
LL
Yao
Li-Qing
LQ
D000328:Adult; D000368:Aged; D002276:Carcinoid Tumor / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*