Role of endoscopic submucosal dissection in treatment of rectal gastroenteropancreatic neuroendocrine neoplasms.
BACKGROUND
A significant rise in incidence of rectal gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) has been observed in the last decade. Most detected gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are well differentiated and less than 2 cm in diameter. Endoscopic submucosal dissection (ESD) is a new method for endoscopic treatment of such tumors, difficult to resect by conventional endoscopic techniques and thus subject to surgical treatment.


OBJECTIVE
To present the results of the endoscopic treatment of GEP NET tumors in the rectum using ESD in single academic center.


METHODS
From June 2013 to April 2014, 4 cases of GEP-NET in the rectum were treated by ESD in our center. Effectiveness of dissection, complications and tumor recurrence after 3 months of treatment were then retrospectively investigated.


RESULTS
The group contained 2 patients with primary rectal GEP-NET (1 male, 1 female; age range: 48-60 years) and 2 with scars after incomplete polypectomy of rectal GEP-NET (1 male, 1 female; 61-65 years). Primary rectal GEP-NET diameters were 0.6 cm and 1.5 cm. Scar resection specimen diameters were 0.7 cm and 1 cm. Mean resection time was 28 min. The en bloc resection rate was 100% (2 of 2) and the histologically complete resection was confirmed in both cases. No foci of neuroendocrine neoplasia were reported in dissected scars. No complications were observed. After 3 months, 3 patients underwent follow-up colonoscopy - no local recurrence was reported.


CONCLUSIONS
Endoscopic submucosal dissection of rectal GEP-NET should be recommended as a treatment of choice when dealing with lesions over 1 cm in diameter without invasion of the muscle layer. Due to technical difficulties, performing this procedure should be reserved for centers with appropriately trained endoscopic staff.
Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland.
Michał
M
Spychalski
Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland.
Włodzimierz
W
Koptas
Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland.
Piotr
P
Zelga
Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland.
Adam
A
Dziki
colorectal; endoscopic submucosal dissection; gastroenteropancreatic neuroendocrine tumors