Comparison of endoscopic submucosal resection with ligation and endoscopic submucosal dissection for small rectal neuroendocrine tumors: A multicenter retrospective study

Abstract

Objectives Endoscopic submucosal resection with band ligation (ESMR‐L) and endoscopic submucosal dissection (ESD) are both standard endoscopic resection methods for rectal neuroendocrine tumors (NETs) <10 mm in size. However, there is no definitive consensus on which is better. Here, we compared the efficacy of ESMR‐L and ESD for small rectal NETs. Methods This was a multicenter retrospective cohort study including 205 patients with rectal NETs who underwent ESMR‐L or ESD. Treatment outcomes were compared by univariate analysis, multivariate analysis, and inverse probability treatment weighting (IPTW) using propensity scores. Subgroup analysis evaluated the impact of the endoscopist's experience on the technical outcome. Results Eighty‐nine patients were treated by ESMR‐L and 116 by ESD. The R0 resection rate was not significantly different between the two (90% vs. 92%, p = 0.73). The procedure time of ESMR‐L was significantly shorter than for ESD (17 min vs. 52 min, p < 0.01) and the hospitalization period was also significantly shorter (3 days vs. 5 days, p < 0.01). These results were confirmed by multivariate analysis and also after IPTW adjustment. The procedure time of ESD was significantly prolonged by a less‐experienced endoscopist (49 min vs. 70 min, p = 0.02), but that of ESMR‐L was not affected (17 min vs. 17 min, p = 0.27). Conclusions For small rectal NETs, both ESMR‐L and ESD showed similar high complete resection rates. However, considering the shorter procedure time and shorter hospitalization period, ESMR‐L is the more efficient treatment method, especially for less‐experienced endoscopists.

Benign Lymphoid Polyp of the Rectum Diagnosed and Treated With Endoscopic Submucosal Resection With a Ligation Device

“…In the ESMR-L procedure, the lesion is aspirated, the submucosa is elevated, and the area is strangulated with band ligation and resected using a snare, thereby achieving free vertical margins. Matsuno et al reported that both ESMR-L and ESD showed similar high complete resection rates for small rectal neuroendocrine tumors [ 12 ]. They concluded that considering the shorter procedure time and shorter hospitalization period, ESMR-L is the more efficient treatment method, especially for less-experienced endoscopists.…”

Optimising Outcomes and Surveillance Strategies of Rectal Neuroendocrine Neoplasms

“…Whilst these are superior to standard polypectomy, they still have high rates of involvement in the deep margin resection, especially in lesions greater than 5 mm. However, a recent study comparing EMR-L vs. ESD in lesions less than 10 mm did not demonstrate a significant difference in R0 resection rates between the two techniques [19]. Therefore, for smaller lesions the choice of resection technique can be determined by the endoscopist's experience and assessment of the lesion.…”

“…There are several different endoscopic resection options. These include standard snare polypectomy, endoscopic mucosal resection (EMR), EMR-band ligation, EMR-cap fitted, EMR-underwater, EMR-ligation (EMR-L), endoscopic submucosal dissection (ESD) and ESD muscle ligation (ML) [17,[19][20][21].…”

Treatment of localized well-differentiated rectal neuroendocrine tumors: A focused review

“…[42,[74][75][76] Modified EMR and ESD have similar benefits. [77][78][79] For endoscopic full-thickness resection, the German registry reported favorable outcomes in 40 cases (median procedure time, 18.5 minutes; negative margins in all cases). [80] Reliable endoscopic resection should be performed using appropriate methods based on an accurate preoperative diagnosis.…”