Endoscopic Treatment of Rectal Neuroendocrine Tumors in a 12 Year Retrospective Single Center Study

Endoscopic management of rectal neuroendocrine tumours. How to avoid a mistake and what to do when one is made?

“…This study also revealed that the neuroendocrine origin of the polyps is suspected in a minority of cases on endoscopy, before the polypectomy is conducted, and even when the diagnosis is suspected, many of rNEN are removed with a snare polypectomy, justifying the continuous education of endoscopists in this field [10]. This conclusion is in accordance with the results of our study, which showed that endoscopists suspected polyps of neuroendocrine origin in only 37.5% of cases (9/24 lesions) [9]. In studies analysing the pathological results of salvage therapies, the presence of remnant tumour in resected scars was reported in a significant number of cases (4/27 in the study by Kumar et al [33], 9/21 in the study by Chen et al [34], 10/24 in the study by Shao et al [35], and in 7/31 cases in the study by Pagano N et al [36]).…”

“…The removal of these lesions with a snare or biopsy forceps results in an unacceptably high rate of incomplete resections [6,7]. The natural history of rNENs shows that using an improper method to remove the tumour puts patients at risk of metastases development, resulting in repeated follow-up radiologic, endoscopic examinations and the need for salvage therapy [8,9].…”

“…Recent studies have shown that the majority of lesions are removed by an improper method, even when typical endoscopic features are present, and diagnoses are made retrospectively based on histopathological assessment [9,10]. Thus, there is still a need to educate physicians caring for patients with rNENs, so that accurate diagnoses are made before the "simple" polypectomy (mistake) is done, and to broaden the knowledge of the management after ineffective treatment [11].…”

A small, yellowish nodule in the rectum: not as benign as it seems

“…When radical treatment is applied, the prognosis for rectal G1 NETs with the diameter up to 10 mm is very good, with nearly 100% 5-year survival rate, and these tumors do not even require followup [1]. Unfortunately, in spite of clear recommendations, what is apparent through our patient's story and other studies, is that majority of these lesions are resected with a snare polypectomy [2,3], what may lead to incomplete resection, and subsequently metastatic spread [2][3][4][5]. Moreover, the important factor that led to the fatal outcome was the fact that the patient was lost for follow-up.…”