title: Endoscopic submucosal resection with a ligation device is an effective and safe treatment for carcinoid tumors in the lower rectum.
abstract: OBJECTIVE
  Various methods for complete endoscopic resection of rectal carcinoid tumors have been reported; however, the number of cases investigated in each study has been limited. The aim of the present study was to clarify the clinical usefulness of a novel technique named endoscopic submucosal resection with a ligation device (ESMR-L) in a large number of rectal carcinoid tumors.
  
  
  METHODS
  Between January 1999 and March 2005, a total of 61 patients with 63 rectal carcinoid tumors estimated at 10 mm or less in diameter, without atypical features and resected by ESMR-L were recruited for this analysis. The complete resection rate, complications associated with the procedure, local recurrence, and distant metastases were evaluated.
  
  
  RESULTS
  Sixty-one patients were 36 males and 25 females with a mean age of 59 +/- 11 years (24-76 years). Tumor size ranged from 2 to 12 mm in diameter, with an average size of 6.4 +/- 2.4 mm. Fifty-nine lesions (93.6%) were located in the lower rectum (Rb), three in the upper rectum (Ra) and one in the recto-sigmoid colon (Rs). In total, 60 out of 63 lesions (95.2%) were histologically determined to be completely resected. The complete resection rate for lesions located in the Rb was 98.3%, which was significantly higher than that for lesions in Ra and Rs (50%). Minor bleeding associated with the procedure occurred in five lesions (7.9%), but all cases were successfully managed with hemoclips. Histopathologically, all tumors were located in the submucosal layer, and all were classified as classical-type carcinoids without lymphovascular invasion. Neither local recurrence nor distant metastasis was detected during a median follow-up period of 24 months.
  
  
  CONCLUSIONS
  In a large number of cases, ESMR-L proved to be a useful and safe procedure to resect rectal carcinoid tumors 10 mm or less in diameter, especially for those located in the Rb.
authors.affiliation: Division of Endoscopy, National Cancer Center Hospital, Tokyo, Japan. yumimashimo07@yahoo.co.jp
authors.forename: Yumi
authors.initials: Y
authors.lastname: Mashimo
authors.forename: Takahisa
authors.initials: T
authors.lastname: Matsuda
authors.forename: Toshio
authors.initials: T
authors.lastname: Uraoka
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sano
authors.forename: Kuangi
authors.initials: K
authors.lastname: Fu
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kozu
authors.forename: Akiko
authors.initials: A
authors.lastname: Ono
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fujii
authors.forename: Daizo
authors.initials: D
authors.lastname: Saito
mesh_terms: D000328:Adult; D000368:Aged; D002276:Carcinoid Tumor / Q000473:pathology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy; D006488:Hemostasis, Surgical; D006801:Humans; D008026:Ligation / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome