Abstract
BackgroundTo compare the outcomes of modified endoscopic mucosal resection (m-EMR) and endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors (NETs) and evaluate the value of endoscopic morphology classification in endoscopic resection (ER).MethodsPatients with rectal NET diameters less than 2 cm who were treated between April 2007 and January 2019 were enrolled. The endoscopic morphology of rectal NETs was classified based on the endoscopic views. Patients who underwent ESD and m-EMR were compared. Baseline characteristics as well as en bloc resection, complete resection, the procedure time, adverse events and the risk factors associated with incomplete resection were analyzed.ResultsA total of 429 patients with 449 rectal NETs were enrolled for the classification of endoscopic morphology and were classified into four types (Ia, IIb, II, and III). There were 79 patients in the m-EMR group and 259 patients in the ESD group before matching. Propensity score matching created 77 pairs between the two groups that were well balanced. The mean procedure time was significantly shorter for m-EMR than for ESD (9.1 ± 4.4 min vs 16.0 ± 7.9 min, P = 0.000). The rates of en bloc resection (98.7% vs 100%; P = 1.000), complete resection (90.9% vs 93.5%, P = 0.548) and adverse events (2.6% vs 2.6%, P = 1.000) were similar between the two groups. Univariate and multivariate analyses showed that histopathological grade and endoscopic morphology were associated with incomplete resection.ConclusionBoth ESD and m-EMR are effective and safe for the treatment of rectal NETs. Endoscopic morphology should be considered along with histopathological grade for ER.
Highlights
To compare the outcomes of modified endoscopic mucosal resection (m-EMR) and endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors (NETs) and evaluate the value of endoscopic morphology classification in endoscopic resection (ER)
Modified endoscopic mucosal resection (M-EMR) was developed from EMR and includes EMR with cap (EMR-C), EMR with ligation (EMR-L), EMR with circumferential incision (EMR-CI) and EMR using a dual-channel endoscope; these have all been proven to be safe and effective methods for treating rectal NETs [13,14,15,16,17] and have been widely used around the world
Endoscopic morphology types A total of 429 patients with NET lesions less than 2 cm in diameter were enrolled in the study of endoscopic morphology type
Summary
To compare the outcomes of modified endoscopic mucosal resection (m-EMR) and endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors (NETs) and evaluate the value of endoscopic morphology classification in endoscopic resection (ER). Rectal NETs are the second most common type of digestive NET after tumors of the small intestine, and their rapidly increasing incidence has been thought to be due to the increased number of colonoscopies [2]. Endoscopic resection (ER), including conventional EMR, m-EMR and ESD, has been shown to be a safe and effective modality for the treatment of small and localized early rectal NETs [7,8,9,10]. M-EMR was developed from EMR and includes EMR with cap (EMR-C), EMR with ligation (EMR-L), EMR with circumferential incision (EMR-CI) and EMR using a dual-channel endoscope; these have all been proven to be safe and effective methods for treating rectal NETs [13,14,15,16,17] and have been widely used around the world. The optimal strategy for ER in rectal NETs still requires additional studies in order to provide strong evidence
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