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Abstract
Background/Aims
Ligation-assisted endoscopic submucosal resection (ESMR-L) is preferred for the treatment of rectal neuroendocrine tumors because its results are better than those for endoscopic mucosal resection (EMR), and the procedure time is shorter and the incidence of complications is lower than endoscopic submucosal dissection. The aim of this study was to evaluate the clinical usefulness of ESMR-L compared with EMR for rectal neuroendocrine tumors.
Methods
From March 2007 to May 2017, 148 patients diagnosed with rectal neuroendocrine tumors were divided into ESMR-L and EMR groups and analyzed retrospectively.
References
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Fig. 1.
Endoscopic mucosal resection. (A) Submucosal tumor is observed. (B) Submucosal saline mixed with epinephrine and indigo carmine solution is injected beneath the neuroendocrine tumor. (C) Elevated tumor is snared. (D) Tumor is resected using high-frequency currents.
Fig. 2.
Endoscopic submucosal resection with a ligation device. (A) Submucosal saline mixed with epinephrine and indigo carmine solution is injected beneath the neuroendocrine tumor. (B) The lesion is aspirated into the ligation device and elastic band is deployed. (C) Snaring below the elastic band. (D) After resection, clear ulcer surface is observed.
Table 1.
Baseline Characteristics of the Study Groups
Table 2.
Characteristics of Tumor
Table 3.
Clinical Outcomes according to Endoscopic Treatment Modality
| ESMR-L (n=120) | EMR (n=28) | p-value | |
|---|---|---|---|
| Procedure time (min) | 7.4±2.1 | 6.6±4.6 | 0.336 |
| Complete resection | 112 (93.3) | 21 (75.0) | 0.009 |
| Curative resection | 111 (92.5) | 20 (71.4) | 0.003 |
| Noncurative resection | |||
| Resection margin involvement | 8 (6.7) | 7 (25.0) | 0.009 |
| Base margin involvement | 3 (2.5) | 6 (21.4) | 0.002 |
| Lateral margin involvement | 0 (0.0) | 0 (0.0) | |
| Both margin involvement | 5 (4.0) | 1 (3.6) | 1.000 |
| Lymphatic invasion | 1 (0.8) | 1 (3.6) | 0.344 |
| Vascular invasion | 1 (0.8) | 0 (0.0) | 1.000 |
| Post-procedure complications a | 7 (5.8) | 1 (3.6) | 1.000 |
| Follow up period, month | 41.8±27.4 | 51.1±24.8 | 0.111 |
| Follow up after non-curative resection | |||
| Surgery | 3 (2.5) | 0 (0.0) | |
| Endoscopic follow up | 6 (5.0) | 5 (17.9) | |
| Follow up loss | 0 (0.0) | 3 (10.7) | |
| Recurrence | 3 (3.2) | 2 (8.0) | 0.278 |
| Follow up loss | 25 (20.8) | 3 (10.7) |
Table 4.
Clinical Features of Patients with Recurrence after Resection of Rectal Neuroendocrine Tumor
|
ESMR-L |
EMR |
||||
|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | |
| Recurrent interval (month) | 22 | 13 | 20 | 33 | 35 |
| Recurrent location, from anal verge | 10 cm | 5 cm | 5 cm | 1 cm | 20 cm |
| Previous resection site recurrence | Yes | Yes | Yes | Yes | No |
| Previous curative resection | No a | Yes | Yes | Yes | Yes |
| Previous tumor size (mm) | 5×5 | 5×5 | 5×5 | 5×5 | 6×6 |
| Tumor with central depression or ulceration | No | No | No | Yes | No |
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