Comparison Between Endoscopic Mucosal Resection with a Cap and Endoscopic Submucosal Dissection for Rectal Neuroendocrine Tumors

Overview

Journal BMC Surg

Publisher Biomed Central

Specialty General Surgery

Date 2022 Jun 27

PMID 35761304

Authors

Xiuli Zheng

Mingli Wu

Huihui Shi

Limian Er

Kan Wang

Ying Cao

Shengmian Li

Affiliations

Soon will be listed here.

Abstract

Background: The aim of this study is to evaluate and compare the safety and efficacy of endoscopic mucosal resection with a cap (EMR-c) with those of endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors (R-NETs) ≤ 15 mm in diameter, and to analyze the risk factors of incomplete resection.

Methods: A total of 122 patients who underwent EMR-c or ESD for R-NETs at the Fourth Hospital of Hebei Medical University between February 2007 and December 2020 were invovled in this study. The clinical outcomes of two groups were compared and evaluated.

Results: A total of 122 patients with 128 R-NETs underwent endoscopic resection (EMR-c, 80; ESD, 48). In terms of duration of operation, EMR-c was significantly shorter than ESD (p < 0.001). Univariate analysis and multivariate analysis suggested that tumor diameter ≥ 8 mm was an independent risk factor for incomplete resection in patients with R-NETs in this study.

Conclusions: Both EMR-c and ESD were safe and effective treatments for R-NETs ≤ 15 mm in diameter. In addition, tumor diameter ≥ 8 mm was an independent risk factor for incomplete resection.

Citing Articles

EMR-C is safe and efficient for rectal neuroendocrine tumor, and easily manageable for novice endoscopists of digestive endoscopy center.

Zhang Z, Liu C Discov Oncol. 2025; 16(1):251.

PMID: 40019663 PMC: 11871194. DOI: 10.1007/s12672-025-01886-9.

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

Zhuang X, Zhang S, Chen G, Luo Z, Hu H, Huang W Gastroenterol Rep (Oxf). 2023; 11:goac084.

PMID: 36632622 PMC: 9825708. DOI: 10.1093/gastro/goac084.

References

Kobayashi K, Katsumata T, Yoshizawa S, Sada M, Igarashi M, Saigenji K . Indications of endoscopic polypectomy for rectal carcinoid tumors and clinical usefulness of endoscopic ultrasonography. Dis Colon Rectum. 2005; 48(2):285-91. DOI: 10.1007/s10350-004-0765-y. View

Sakai M, Kajiyama T, KIN G, Inoue K, Torii A, Kishimoto H . Endoscopic resection of rectal carcinoid tumors using aspiration lumpectomy. Endoscopy. 1997; 29(1):34-8. DOI: 10.1055/s-2007-1024058. View

Modlin I, Kidd M, Latich I, Zikusoka M, Shapiro M . Current status of gastrointestinal carcinoids. Gastroenterology. 2005; 128(6):1717-51. DOI: 10.1053/j.gastro.2005.03.038. View

Kang H, Kwon M, Kim T, Han J, Ju Y . Lymphovascular invasion as a prognostic value in small rectal neuroendocrine tumor treated by local excision: A systematic review and meta-analysis. Pathol Res Pract. 2019; 215(11):152642. DOI: 10.1016/j.prp.2019.152642. View

Takita M, Sakai E, Nakao T, Kimoto Y, Ishii R, Konishi T . Clinical Outcomes of Patients with Small Rectal Neuroendocrine Tumors Treated Using Endoscopic Submucosal Resection with a Ligation Device. Digestion. 2018; 99(1):72-78. DOI: 10.1159/000494416. View

Choi C, Park S, Kang D, Kim H, Kim S, Nam H . The clinical outcomes and risk factors associated with incomplete endoscopic resection of rectal carcinoid tumor. Surg Endosc. 2017; 31(12):5006-5011. DOI: 10.1007/s00464-017-5497-x. View

Park S, Kim H, Kang D, Choi C, Kim S, Nam H . Advantage of endoscopic mucosal resection with a cap for rectal neuroendocrine tumors. World J Gastroenterol. 2015; 21(31):9387-93. PMC: 4541391. DOI: 10.3748/wjg.v21.i31.9387. View

Chen R, Liu X, Sun S, Wang S, Ge N, Wang G . Comparison of Endoscopic Mucosal Resection With Circumferential Incision and Endoscopic Submucosal Dissection for Rectal Carcinoid Tumor. Surg Laparosc Endosc Percutan Tech. 2016; 26(3):e56-61. DOI: 10.1097/SLE.0000000000000266. View

Wang X, Chai N, Linghu E, Qiu S, Li L, Zou J . The outcomes of modified endoscopic mucosal resection and endoscopic submucosal dissection for the treatment of rectal neuroendocrine tumors and the value of endoscopic morphology classification in endoscopic resection. BMC Gastroenterol. 2020; 20(1):200. PMC: 7318520. DOI: 10.1186/s12876-020-01340-w. View

10.

Ahmed Y, Othman M . EMR/ESD: Techniques, Complications, and Evidence. Curr Gastroenterol Rep. 2020; 22(8):39. DOI: 10.1007/s11894-020-00777-z. View

11.

Lee J, Park Y, Choi J, Heo N, Park J, Park S . Comparison between cap-assisted and ligation-assisted endoscopic mucosal resection for rectal neuroendocrine tumors. Ann Gastroenterol. 2020; 33(4):385-390. PMC: 7315720. DOI: 10.20524/aog.2020.0485. View

12.

Hamada Y, Tanaka K, Hattori A, Umeda Y, Yukimoto H, Yamada R . Clinical utility of endoscopic submucosal dissection using the pocket-creation method with a HookKnife and preoperative evaluation by endoscopic ultrasonography for the treatment of rectal neuroendocrine tumors. Surg Endosc. 2021; 36(1):375-384. DOI: 10.1007/s00464-021-08292-6. View

13.

Kim J, Kim J, Lee J, Chun J, Im J, Kim J . Clinical outcomes of endoscopic mucosal resection for rectal neuroendocrine tumor. BMC Gastroenterol. 2018; 18(1):77. PMC: 5987588. DOI: 10.1186/s12876-018-0806-y. View

14.

Sivandzadeh G, Ejtehadi F, Shoaee S, Aminlari L, Niknam R, Taghavi A . Endoscopic mucosal resection: still a reliable therapeutic option for gastrointestinal neuroendocrine tumors. BMC Gastroenterol. 2021; 21(1):238. PMC: 8142474. DOI: 10.1186/s12876-021-01821-6. View

15.

Yang D, Park Y, Park S, Kim K, Ye B, Byeon J . Cap-assisted EMR for rectal neuroendocrine tumors: comparisons with conventional EMR and endoscopic submucosal dissection (with videos). Gastrointest Endosc. 2015; 83(5):1015-22. DOI: 10.1016/j.gie.2015.09.046. View

16.

Oshitani N, Hamasaki N, Sawa Y, Hara J, Nakamura S, Matsumoto T . Endoscopic resection of small rectal carcinoid tumours using an aspiration method with a transparent overcap. J Int Med Res. 2000; 28(5):241-6. DOI: 10.1177/147323000002800507. View

17.

Coutinho L, Lenz L, Kawaguti F, Martins B, Baba E, Gusmon C . UNDERWATER ENDOSCOPIC MUCOSAL RESECTION FOR SMALL RECTAL NEUROENDOCRINE TUMORS. Arq Gastroenterol. 2021; 58(2):210-213. DOI: 10.1590/S0004-2803.202100000-37. View

18.

Gu Q, Lin Y, Cen L, Xu M, Li H, Lin X . Endoscopic ultrasonography is useful in the diagnosis and treatment of rectal neuroendocrine neoplasms: a case series. J Zhejiang Univ Sci B. 2019; 20(10):861-864. PMC: 6751482. DOI: 10.1631/jzus.B1900168. View

19.

Park S . Tips and tricks for better endoscopic treatment of colorectal tumors: usefulness of cap and band in colorectal endoscopic mucosal resection. Clin Endosc. 2013; 46(5):492-4. PMC: 3797932. DOI: 10.5946/ce.2013.46.5.492. View

20.

Folkert I, Sinnamon A, Concors S, Bennett B, Fraker D, Mahmoud N . Grade is a Dominant Risk Factor for Metastasis in Patients with Rectal Neuroendocrine Tumors. Ann Surg Oncol. 2019; 27(3):855-863. DOI: 10.1245/s10434-019-07848-0. View