Ligation-assisted endoscopic mucosal resection has high complete resection rate in rectal carcinoid tumor

Ming-Yao Su,Cheng-Tang Chiu

doi:10.1186/s12876-021-02061-4

Abstract

AimWe aimed to compare the outcomes of different therapeutic modalities in rectal carcinoid tumors.MethodWe retrospectively collected 145 patients with rectal carcinoid tumors which were pathologically diagnosed from 2005/01/01 to 2016/12/31. We compared tumor size, complete resection rate and recurrent rate between different therapeutic modalities. Then, prospectively compared the treatment outcomes of 28 patients treated with ligation assisted endoscopic mucosal resection (LEMR) and 25 patients treated with endoscopic mucosal resection with cap (EMRC).ResultThe mean size of tumors was 6.5 mm (1–25 mm), and the mean follow-up duration was 26 months (6–118 months). The therapeutic modalities included ligation-assisted endoscopic mucosal resection (LEMR) (25 tumors, 17%), endoscopic mucosal resection (EMR) (31 tumors, 21%), snare polypectomy (30 tumors, 21%), biopsy forceps removal (46 tumors, 32%) and surgical resection (13 tumors, 11%), including 6 tumors treated with transanal endoscopic microsurgery (TEM) method. In view of pathologically complete resection rate, LEMR was highest (100%), followed by surgical resection (85%). However, EMR only had 42% pathologically complete resection rate. Besides, LEMR and surgical resection had no local recurrence and significantly higher clinically complete resection rate, compared to other treatments. For the further prospective study, complete resection was noted in 28 (100%) patients in LEMR group and 13 (52%) patients in EMRC group.ConclusionIn the treatment of rectal carcinoid tumors, LEMR is safe and effective compared with traditional endoscopic treatments.

Highlights

Rectal carcinoid tumors are usually found incidentally during endoscopic examination
In the treatment of rectal carcinoid tumors, ligation-assisted endoscopic mucosal resection (LEMR) is safe and effective compared with traditional endo‐ scopic treatments
The typically endoscopic appearance of rectal carcinoid tumors is smooth, round, sessile elevations covered with normal-appearing or yellow-discolored mucosa [1]

Summary

Introduction

Rectal carcinoid tumors are usually found incidentally during endoscopic examination. We can evaluate the malignant potential of rectal carcinoid tumors according to tumor size, endoscopic features, histological growth patterns, muscularis propria invasion, and lymphovascular invasion [1,2,3]. Among these parameters, primary tumor size is most simple and reliable predictor. Previous studies suggested local resection for the carcinoid tumors less than 10 mm and confined to the submucosa because of low metastatic rate [7]

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