Intest Res.  2016 Apr;14(2):164-171. 10.5217/ir.2016.14.2.164.

Usefulness of endoscopic resection using the band ligation method for rectal neuroendocrine tumors

• Kim JS
• Kim YJ
• Chung JW
• Kim JH
• Kim KO
• Kwon KA
• Park DK
• An JS

• KMID: 2425289
• DOI: http://doi.org/10.5217/ir.2016.14.2.164

Abstract

BACKGROUND/AIMS
Rectal neuroendocrine tumors (NETs) are among the most common of gastrointestinal NETs. Due to recent advances in endoscopy, various methods of complete endoscopic resection have been introduced for small (≤10 mm) rectal NETs. However, there is a debate about the optimal treatment for rectal NETs. In our study, we aimed to evaluate the efficacy and feasibility of endoscopic resection using pneumoband and elastic band (ER-BL) for rectal NETs smaller than 10 mm in diameter.
METHODS
A total of 55 patients who were diagnosed with rectal NET from January 2004 to December 2011 at Gil Medical Center were analyzed retrospectively. Sixteen patients underwent ER-BL. For comparison, 39 patients underwent conventional endoscopic mucosal resection (EMR).
RESULTS
There was a markedly lower deep margin positive rate for ER-BL than for conventional EMR (6% [1/16] vs. 46% [18/39], P=0.029). Four patients who underwent conventional EMR experienced perforation or bleeding. However, they recovered within a few days. On the other hand, patients whounderwent endoscopic resection using a pneumoband did not experience any complications. In multivariate analysis, ER-BL (P=0.021) was independently associated with complete resection.
CONCLUSIONS
ER-BL is an effective endoscopic treatment with regards to deep margin resection for rectal NET smaller than 10 mm.

Keyword

Neuroendocrine tumors; Rectum; Pneumoband; Elastic band; Endoscopic mucosal resection

MeSH Terms

Endoscopy
Hand
Hemorrhage
Humans
Ligation*
Multivariate Analysis
Neuroendocrine Tumors*
Rectum
Retrospective Studies

Figure

• 

  Fig. 1 Endoscopic resection using pneumoband (ER-PB). (A) Endoscopic view of an approximately 5 mm in diameter rectal NET. (B) The tumor is ligated with the pneumoband with or without submucosal injection. (C) The section immediately below the band is resected using a snare. (D) A post ER-PB ulcer.

• 

  Fig. 2 Endoscopic resection using an elastic band. (A) Endoscopic view of an approximately 5 mm in diameter rectal NET. (B, C) The tumor is aspirated and ligated with an endoscopic variceal ligation cap and band. (D) The section immediately below the band is resected using a snare.

• 

  Fig. 3 Conventional endoscopic mucosal resection. (A) Endoscopic view of an approximately 6 mm in diameter rectal NET. (B) Submucosal injection is performed. (C) Snaring of the elevated mucosal lesion is performed. (D) A post polypectomy ulcer.

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  Fig. 4 Flow chart of rectal neuroendocrine tumor patients who underwent endoscopic resection. ER-BL, endoscopic resection using pneumoband and elastic band; EMR, endoscopic mucosal resection; f/u, follow up; APCT, abdominopelvic CT.

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