Role of endoscopic submucosal dissection in treatment of rectal gastroenteropancreatic neuroendocrine neoplasms

Abstract

IntroductionA significant rise in incidence of rectal gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) has been observed in the last decade. Most detected gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are well differentiated and less than 2 cm in diameter. Endoscopic submucosal dissection (ESD) is a new method for endoscopic treatment of such tumors, difficult to resect by conventional endoscopic techniques and thus subject to surgical treatment.AimTo present the results of the endoscopic treatment of GEP NET tumors in the rectum using ESD in single academic center.Material and methodsFrom June 2013 to April 2014, 4 cases of GEP-NET in the rectum were treated by ESD in our center. Effectiveness of dissection, complications and tumor recurrence after 3 months of treatment were then retrospectively investigated.ResultsThe group contained 2 patients with primary rectal GEP-NET (1 male, 1 female; age range: 48–60 years) and 2 with scars after incomplete polypectomy of rectal GEP-NET (1 male, 1 female; 61–65 years). Primary rectal GEP-NET diameters were 0.6 cm and 1.5 cm. Scar resection specimen diameters were 0.7 cm and 1 cm. Mean resection time was 28 min. The en bloc resection rate was 100% (2 of 2) and the histologically complete resection was confirmed in both cases. No foci of neuroendocrine neoplasia were reported in dissected scars. No complications were observed. After 3 months, 3 patients underwent follow-up colonoscopy – no local recurrence was reported.ConclusionsEndoscopic submucosal dissection of rectal GEP-NET should be recommended as a treatment of choice when dealing with lesions over 1 cm in diameter without invasion of the muscle layer. Due to technical difficulties, performing this procedure should be reserved for centers with appropriately trained endoscopic staff.

Risk factors associated with the progression and metastases of hindgut neuroendocrine tumors: a retrospective study

“…Recently, an increased incidence of GEP-NETs has been reported globally, with the rectum, considered as the “intestine” of the hindgut, being the most common site of occurrence [ 1 , 12 ]. Therefore, elucidating the mechanisms of hindgut NET progression and metastasis is important, and this study was specifically conducted to evaluate the risk factors associated with tumor progression and metastasis in hindgut NET.…”

Risk factors and clinical outcomes of incomplete endoscopic resection of small rectal neuroendocrine tumors in southern China: a 9-year data analysis

“…Cold-forceps polypectomy and snare polypectomy are not recommended due to the lack of assurance of sufficient CR of the lesion margins. Even for larger RNETs (10–19 mm) without metastasis and muscularis propria invasion, ESD is effective for resection of RNETs due to the advantages of en bloc resection and accurate pathological assessment [ 6 , 7 ]. However, despite the rapid development of endoscopic technologies, it remains difficult in clinics to achieve a satisfactory complete resection (CR) rate for RNETs.…”

Concomittant Liver Transplantation and Low Anterior Resection in Patient with Neuroendocrine Tumor and Chronic Hepatitis B Infection

“…The 5-year survival rates are reported to be 88%, and the prognosis is relatively good [ 1 ]. Surgery is the only means of cure in GEP-NETs [ 3 ]. Various therapeutic options including liver resection can be applied for the treatment of liver metastasis of NETs.…”