Successful outcomes of EMR-L with 3D-EUS for rectal carcinoids compared with historical controls.
OBJECTIVE
To assess the results of endoscopic mucosal resection with a ligation device (EMR-L) combined with three dimensional endoscopic ultrasonography (3D-EUS) using an ultrasonic probe for rectal carcinoids. In addition, diagnosis of the depth and size of lesions by EUS was evaluated.


METHODS
Between January 2003 and March 2007, 20 patients underwent EMR-L with 3D-EUS using an ultrasonic probe (group A). 3D-EUS was combined with EMR-L at the time of injection of sterile physiological saline into the submucosal layer. For comparison, 14 rectal carcinoids that had been treated by EMR-L without 3D-EUS between April 1998 and December 2002 were evaluated as historical controls (group B). EUS was conducted for all of the patients before treatment to evaluate tumor diameter and depth of invasion. The percentage of complete resection and the vertical resection margin were compared between the two groups.


RESULTS
The depth of invasion upon histopathological examination was in complete agreement with the pre-operative findings by EUS. The tumor diameter determined by EUS approximated that found in the tissue samples. There were no significant differences in the gender, tumor sites or tumor diameters between the two groups. The rate of complete resection for groups A and B was 100% and 71%, respectively (P<0.05). The vertical resection margin of group A was longer than that of group B.


CONCLUSIONS
EMR-L is effective as an endoscopic treatment for rectal carcinoids. In combination with 3D-EUS, safe and complete resection is further assured.
Abe
Tsuyoshi
T
Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi Meguro-ku, Tokyo 153-8515, Japan. tsuys@d6.dion.ne.jp
Kakemura
Tadayoshi
T
Fujinuma
Sumio
S
Maetani
Iruru
I
D000368:Aged; D002276:Carcinoid Tumor / Q000000981:diagnostic imaging / Q000601:surgery*; D016022:Case-Control Studies; D020685:Colonoscopes; D003113:Colonoscopy / Q000379:methods*; D019160:Endosonography; D004867:Equipment Design; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000601:surgery; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome