Endoloop ligation after endoscopic mucosal resection using a transparent cap: A novel method to treat small rectal carcinoid tumors

Abstract

BACKGROUNDLocal endoscopic resection is an effective method for the treatment of small rectal carcinoid tumors, but remnant tumor at the margin after resection remains to be an issue.AIMTo evaluate the efficacy and safety of resection of small rectal carcinoid tumors by endoloop ligation after cap-endoscopic mucosal resection (LC-EMR) using a transparent cap.METHODSThirty-four patients with rectal carcinoid tumors of less than 10 mm in diameter were treated by LC-EMR (n = 22) or endoscopic submucosal dissection (ESD) (n = 12) between January 2016 and December 2017. Demographic data, complete resection rates, pathologically complete resection rates, operation duration, and postoperative complications were collected. All cases were followed for 6 to 30 mo.RESULTSA total of 22 LC-EMR cases and 12 ESD cases were enrolled. The average age was 48.18 ± 12.31 and 46.17 ± 12.57 years old, and the tumor size was 7.23 ± 1.63 mm and 7.50 ± 1.38 mm, respectively, for the LC-EMR and ESD groups. Resection time in the ESD group was longer than that in the LC-EMR group (15.67 ± 2.15 min vs 5.91 ± 0.87 min; P < 0.001). All lesions were completely resected at one time. No perforation or delayed bleeding was observed in either group. Pathologically complete resection (P-CR) rate was 86.36% (19/22) and 91.67% (11/12) in the LC-EMR and ESD groups (P = 0.646), respectively. Two of the three cases with a positive margin in the LC-EMR group received transanal endoscopic microsurgery (TEM) and tumor cells were not identified in the postoperative specimens. The other case with a positive margin chose follow-up without further operation. One case with remnant tumor after ESD received further local ligation treatment. Neither local recurrence nor lymph node metastasis was found during the follow-up period.CONCLUSIONLC-EMR appears to be an efficient and simple method for the treatment of small rectal carcinoid tumors, which can effectively avoid margin remnant tumors.

Endoscopic submucosal dissection versus endoscopic mucosal resection for rectal carcinoid tumor. A meta‐analysis and meta‐regression with single‐arm analysis

“…Though statistical significance was not reached, this could be the result of the low absolute number of recurrence due to limited follow‐up of 12‐48 months and the high natural survival rate of rectal carcinoid tumors. The use of EMR was associated with a 4‐fold increase in the risk of additional procedures, which is consistent with existing studies that attribute this to lymphovascular invasion and the failure to achieve complete resection margins 21,23,25,27,29,40,41 …”

“…The detailed PRISMA flowchart of this review is shown in Figure 1. In total, four articles originated from Japan, 21–24 10 originated from South Korea, 25–34 and eight were from China, 35–42 respectively; 21 of these studies were retrospective cohort studies, while the other was a prospective cohort study. This review summarizes the data from 655 ESD and 705 EMR procedures, and thus summarized results from the resection of 1360 rectal lesions.…”

Endoscopic full thickness resection vs. transanal endoscopic microsurgery for local treatment of rectal neuroendocrine tumors - a retrospective analysis

“…Thus, advanced EMR techniques have been evaluated to improve local R0 rate. The most frequently used techniques are EMR-C and EMR-L, with R0 rates between 80 and 100% [4][5][6]17]. Another established resection technique for rectal NETs is ESD; however, this method is challenging, more complicated, and especially in western countries limited to few specialized centers.…”

“…Another established resection technique for rectal NETs is ESD; however, this method is challenging, more complicated, and especially in western countries limited to few specialized centers. Therefore, it is not surprising that R0 resection rate in recent Asian studies is about 90 to 100% while the only European study found only about 80% [4][5][6]. The main reason for incomplete resection of rectal NETs are remaining tumor cells in the deeper part of the submucosal layer; therefore, histopathological R1 situation sometimes occurs at the vertical margin of resected specimens, even if EMR-L/C or ESD technique is used [4].…”

“…Local treatment options include classical endoscopic methods (e.g. mucosectomy), advanced endoscopic techniques (endoscopic resection using an endoscopic variceal ligation device (EMR-L) or suction cap technique (EMR-C), endoscopic submucosal dissection (ESD), endoscopic full thickness resection (eFTR)), and transanal endoscopic microsurgery (TEM) with increased R0 resection rates according to advanced/invasive techniques [4][5][6][7][8]. A recent publication reported excellent R0 rates, using eFTR for rectal NET treatment.…”