title: Feasibility of salvage endoscopic mucosal resection by using a cap for remnant rectal carcinoids after primary EMR.
abstract: BACKGROUND
  Secondary endoscopic treatment for remnant lesions of rectal carcinoid tumors after primary EMR or polypectomy is technically difficult because of fibrosis of residual tissues. EMR by using a cap (EMR-C), a method to resect the submucosal layer by suction by using a transparent cap, may be feasible as a salvage treatment.
  
  
  OBJECTIVE
  To assess the feasibility of salvage EMR-C.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Tertiary academic health care system.
  
  
  METHODS
  Thirty-one patients who were referred for salvage treatment of a failed en bloc excision of rectal carcinoid tumors after primary EMR or polypectomy between January 2007 and December 2009.
  
  
  METHODS
  Salvage EMR-C for remnant carcinoid tumors in the rectum.
  
  
  METHODS
  Rate of complete resection, complications, length of procedure, and recurrence rate.
  
  
  RESULTS
  The mean age of the patients was 52.0±11.8 years (range 30-78 years). The mean tumor size was 8.9±3.2 mm (range 5.0-13.0 mm). The mean procedure time was 9.1±3.7 minutes, and clear resection margins were pathologically confirmed in all 31 patients. The most common complication of salvage EMR-C was bleeding (7 patients, 22.6%), which was successfully treated by hemoclipping in all cases. The 1-year follow-up colonoscopy and CT results for all patients were negative for recurrence.
  
  
  CONCLUSIONS
  Retrospective design and limited cases at a single center.
  
  
  CONCLUSIONS
  EMR-C is a feasible salvage therapeutic option for failed en bloc excision after primary endoscopic treatment of rectal carcinoid tumors.
authors.affiliation: Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Soung Min
authors.initials: SM
authors.lastname: Jeon
authors.forename: Jin Ha
authors.initials: JH
authors.lastname: Lee
authors.forename: Sung Pil
authors.initials: SP
authors.lastname: Hong
authors.forename: Tae Il
authors.initials: TI
authors.lastname: Kim
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cheon
mesh_terms: D000328:Adult; D000368:Aged; D002276:Carcinoid Tumor / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology*; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies