A tailored approach for endoscopic treatment of small rectal neuroendocrine tumor.
BACKGROUND
Resection of rectal neuroendocrine tumors (NETs) less than 1 cm in diameter can be performed using various endoscopic techniques. Endoscopic mucosal resection (EMR) traditionally had suboptimal complete resection rate compared to endoscopic submucosal resection with band ligation (ESMR-L). However, the previous studies did not consider the characteristics of rectal NETs. The aim of our study is to compare the efficacy of ESMR-L and EMR using tailored approach according to the characteristics of rectal NETs.


METHODS
82 rectal NETs in 77 patients treated by ESMR-L (n = 48) or EMR (n = 34) between September 2007 and October 2012 were retrospectively analyzed. ESMR-L was used for flat-type tumors or tumors with non-lifting sign after submucosal injection. Conventional EMR was used for elevated-type tumors or tumors with well-lifting sign after submucosal injection.


RESULTS
The pathological complete resection rate was higher in the ESMR-L group (45 lesions, 93.8%) compared with the EMR group (30 lesions, 88.2%); however, this difference was not significant (p = 0.441). Overall complication did not differ significantly between the ESMR-L group and the EMR group (p = 0.774). There was one case of a remnant lesion in the ESMR-L group, which was managed by EMR after circumferential pre-cutting (EMR-P), and no recurrence has been detected in either the ESMR-L or EMR group.


CONCLUSIONS
ESMR-L and EMR procedures could have a similar excellent complete resection rate, if we select the endoscopic resection technique according to the characteristics of the small rectal NETs.
Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
Jun
J
Heo
Seong Woo
SW
Jeon
Min Kyu
MK
Jung
Sung Kook
SK
Kim
Geun Young
GY
Shin
Sang Man
SM
Park
Sun Young
SY
Ahn
Won Kyung
WK
Yoon
Min
M
Kim
Yong Hwan
YH
Kwon
D000328:Adult; D000368:Aged; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery; D008026:Ligation / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D019106:Postoperative Hemorrhage; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies