Clin Endosc.  2017 Nov;50(6):585-591. 10.5946/ce.2017.039.

Efficacy of Precut Endoscopic Mucosal Resection for Treatment of Rectal Neuroendocrine Tumors

• So H
• Yoo SH
• Han S
• Kim GU
• Seo M
• Hwang SW
• Yang DH
• Byeon JS

• KMID: 2398310
• DOI: http://doi.org/10.5946/ce.2017.039

Abstract

BACKGROUND/AIMS
Endoscopic resection is the first-line treatment for rectal neuroendocrine tumors (NETs) measuring < 1 cm and those between 1 and 2 cm in size. However, conventional endoscopic resection cannot achieve complete resection in all cases. We aimed to analyze clinical outcomes of precut endoscopic mucosal resection (EMR-P) used for the management of rectal NET.
METHODS
EMR-P was used to treat rectal NET in 72 patients at a single tertiary center between 2011 and 2015. Both, circumferential precutting and EMR were performed with the same snare device in all patients. Demographics, procedural details, and histopathological features were reviewed for all cases.
RESULTS
Mean size of the tumor measured endoscopically was 6.8±2.8 mm. En bloc and complete resection was achieved in 71 (98.6%) and 67 patients (93.1%), respectively. The mean time required for resection was 9.0±5.6 min. Immediate and delayed bleeding developed in six (8.3%) and 4 patients (5.6%), respectively. Immediate bleeding observed during EMR-P was associated with the risk of delayed bleeding.
CONCLUSIONS
Both, the en bloc and complete resection rates of EMR-P in the treatment of rectal NETs using the same snare for precutting and EMR were noted to be high. The procedure was short and safe. EMR-P may be a good treatment choice for the management of rectal NETs.

Keyword

Rectum; Carcinoid tumor; Neuroendocrine tumors; Endoscopic mucosal resection

MeSH Terms

Carcinoid Tumor
Demography
Hemorrhage
Humans
Neuroendocrine Tumors*
Rectum
SNARE Proteins
SNARE Proteins

Figure

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  Fig. 1. Precut endoscopic mucosal resection of a rectal neuroendocrine tumor (NET). (A) A 9 mm sized rectal NET. (B) Following submucosal injection into the tumor, the tip of the snare is introduced for circumferential incision/precutting. (C) Precutting around the tumor. (D, E) Secure snaring in the precut mucosal groove. (F) A clear post-resection ulcer base is seen.

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