Abstract
Purpose: Complete resection of rectal carcinoid tumors is difficult with conventional polypectomy because these tumors extend mainly into submucosal layer. And deeper incision to achieve clean margin can make complications such as bleeding or perforation. In this study, we evaluated the efficacy and safety of endoscopic submucosal resection with double ligations (ESMR-DL) for the treatment of small rectal carcinoid tumors in comparison with strip biopsy. Methods: We performed strip biopsy or ESMR-DL between April 2000 and November 2004. Eleven carcinoid tumors were resected by strip biopsy, and eleven tumors were resected by ESMR-DL. ESMR-DL was carried out with a conventional single channel endoscope with attached band ligator device. The lesion was aspirated into the ligator device, followed by deployment of the elastic band. And then ligation was performed below the elastic band by using a detachable snare. Snare resection was performed above the elastic band. ESMR-DL was compared with strip biopsy regarding complete resection rate, distance of vertical resection margin, and complication rate. Results: Two groups were similar with respect to location, shape, and size of tumors. The rate of complete removal of carcinoid tumors with ESMR-DL (100%) was significantly higher (p= 0.035) than that with strip biopsy (55%). The mean vertical resection margin in ESMR-DL (832.3 ± 589.4 μ) also was significantly deeper (p= 0.001) than that in strip biopsy (158.6 ± 24.7 μ). The rate of complications with ESMR-DL (0%) was significantly lower (p= 0.035) than that of strip biopsy (45%). There was no local recurrence or distant metastases in any patients treated with ESMR-DL during the mean follow-up period of 24 months. Conclusions: Endoscopic submucosal resection with double ligations is a useful and safe method for the treatment of small rectal carcinoid tumors. [figure 1]Figure
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