Endoscopic mucosal resection with a ligation device or endoscopic submucosal dissection for rectal carcinoid tumors: an analysis of 24 consecutive cases.
OBJECTIVE
Endoscopic submucosal dissection (ESD) has several advantages over conventional endoscopic mucosal resection, including a higher en bloc resection rate and more accurate pathological estimation. However, ESD is a complex procedure that requires advanced endoscopic skills. The aim of our study is to evaluate the efficacy of endoscopic mucosal resection with a ligation device (EMR-L) compared to ESD for rectal carcinoid tumors.


METHODS
Between September 2003 and April 2011, 24 rectal carcinoid tumors in 24 patients treated by ESD or EMR-L were retrospectively analyzed. The indications for endoscopic treatment were node-negative rectal carcinoid tumors. We compared the therapeutic outcomes of the ESD group (n = 13) and the EMR-L group (n = 11).


RESULTS
Both groups had similar mean tumor sizes (ESD: 5.5 ± 2.1 mm; EMR-L: 4.4 ± 2.2 mm). The rates of en bloc and complete resection were, respectively, 100% and 92.3% for ESD, and 100% and 100% for EMR-L. Perforations did not occur in either group. Postoperative bleeding occurred in one EMR-L case, and it was endoscopically managed. However, there were no differences in therapeutic outcomes between the two groups. The mean procedure time was longer in the ESD group (28.8 ± 16.2 min) than in the EMR-L group (17.4 ± 4.4 min), without a significant difference. The mean hospitalization period was significantly shorter in the EMR-L group (1.8 ± 3.1 day) than in the ESD group (6.2 ± 2.1 day), and eight EMR-L cases were treated in an outpatient setting.


CONCLUSIONS
EMR-L is a simple and effective procedure that compares favorably to ESD for small rectal carcinoid tumors.
Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan. k-niimi@umin.ac.jp
Keiko
K
Niimi
Osamu
O
Goto
Mitsuhiro
M
Fujishiro
Shinya
S
Kodashima
Satoshi
S
Ono
Satoshi
S
Mochizuki
Itsuko
I
Asada-Hirayama
Maki
M
Konno-Shimizu
Rie
R
Mikami-Matsuda
Chihiro
C
Minatsuki
Nobutake
N
Yamamichi
Kazuhiko
K
Koike
D002276:Carcinoid Tumor / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008026:Ligation / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011351:Proctoscopy / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome