Resectability of Rectal Neuroendocrine Tumors Using Endoscopic Mucosal Resection with a Ligation Band Device and Endoscopic Submucosal Dissection

Abstract

Background Rectal neuroendocrine tumors (NETs) < 10 mm in diameter, limited to the submucosa without local or distant metastasis, can be treated endoscopically. Endoscopic mucosal resection with a ligation band device (EMR-L) and endoscopic submucosal dissection (ESD) have been employed to resect rectal NETs. We evaluated and compared the clinical outcomes of EMR-L and ESD for endoscopic resection of rectal NETs G1 < 10 mm in diameter. Methods We conducted a retrospective study of 82 rectal NETs in 82 patients who underwent either EMR-L or ESD. Therapeutic outcomes (en bloc resection and complete resection rates), procedure time, and procedure-related adverse events were evaluated. Additionally, we measured the distance of the lateral and vertical margins from the border of the tumor in pathologic specimens and compared the resectability between EMR-L and ESD. Results Sixty-six lesions were treated using EMR-L and 16 using ESD. En bloc resection was achieved in all patients. The complete resection rate with EMR-L was significantly higher than that with ESD (95.5% vs.75.0%, p = 0.025). The prevalence of vertical margin involvement was significantly higher in the ESD group than in the EMR-L group (12.5% vs. 0%, p = 0.036), and ESD was more time consuming than EMR-L (24.21 ± 12.18 vs. 7.05 ± 4.53 min, p < 0.001). The lateral and vertical margins were more distant in the EMR-L group than in the ESD group (lateral margin distance, 1661 ± 849 vs. 1514 ± 948 μm; vertical margin distance, 277 ± 308 vs. 202 ± 171 μm). Conclusions EMR-L is more favorable for small rectal NETs with respect to therapeutic outcomes, procedure time, and technical difficulties. Additionally, EMR-L enables achievement of sufficient vertical margin distances.

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

“…However, a sensitivity analysis of tumors <10 mm in the current study showed that ESD and EMR achieved similar en bloc resection, vertical and lateral margin involvement, complete resection, and recurrence. EMR may resect small tumors with comparable quality to ESD, which is also supported by findings from a previous meta‐analysis 45 . Thus, while existing guidelines 5,6 differ on how to manage rectal carcinoid tumors, this review suggests that both ESD and EMR are effective for treating rectal carcinoid tumors smaller than 10 mm.…”

Clinical outcomes of endoscopic resection for rectal neuroendocrine tumors: Advantages of endoscopic submucosal resection with a ligation device compared to conventional EMR and ESD

“…Lim et al. 15 reported that the lateral and VM were longer in the ESMR‐L group than in the ESD group. Kim et al.…”

“…Previous reports demonstrated that ESMR‐L achieved a complete resection rate not inferior to ESD. 13 , 14 , 15 However, ESD requires a longer procedure time and more advanced endoscopic techniques than ESMR‐L. Moreover, there are few reports comparing the results of different ER methods.…”

Modified endoscopic mucosal resection techniques for treating precancerous colorectal lesions

“…In another study, ESMR-L once again outperformed C-EMR in terms of histologically complete resection (27/29, 93.1% vs. 82/110, 74.5%, P=0.03) for rectal neuroendocrine tumors with average size 7 mm, while at the same time the technique also showed valuable results in the long term [ 74 , 75 ]. Preliminary data suggested that the method even achieves at least equal resection outcomes to ESD for rectal carcinoid tumors <10 mm in size (complete resection rate 24/29, 82.8% vs. 25/31, 80.6% P=0.83) [ 76 ]; however, more recently it was shown that ESMR-L may in fact be even more superior to ESD for similar lesions, with respect to therapeutic outcomes and procedure time (95.5% vs.75.0%, P=0.02 for complete resection rate and 7.1±4.5 vs. 24.2±12.1 min, P<0.001, for resection time, respectively) [ 77 ]. In the largest prospective study comparing the efficacy and safety of the method and ESD for small rectal NETs (≤10 mm) [ 78 ], ESMR-L outperformed ESD, achieving a significantly higher pathological complete resection rate (53/53, 100% vs. 13/24, 54.2%, P<0.001).…”