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Comparative Study
. 2015 Aug 21;21(31):9387-93.
doi: 10.3748/wjg.v21.i31.9387.

Advantage of endoscopic mucosal resection with a cap for rectal neuroendocrine tumors

Su Bum Park  1 , Hyung Wook Kim  1 , Dae Hwan Kang  1 , Cheol Woong Choi  1 , Su Jin Kim  1 , Hyeong Seok Nam  1
Affiliations
Comparative Study

Advantage of endoscopic mucosal resection with a cap for rectal neuroendocrine tumors

Su Bum Park et al. World J Gastroenterol. .

Abstract

Aim: To compare the outcomes of endoscopic mucosal resection with a cap (EMR-C) with those of endoscopic submucosal dissection (ESD) for the resection of rectal neuroendocrine tumors.

Methods: One hundred and sixteen lesions in 114 patients with rectal neuroendocrine tumor (NET) resected with EMR-C or ESD were included in the study. This study was performed at Pusan National University Yangsan Hospital between July 2009 and August 2014. We analyzed endoscopic complete resection rate, pathologic complete resection rate, procedure time, and adverse events in the EMR-C (n = 65) and ESD (n = 51) groups. We also performed a subgroup analysis by tumor size.

Results: Mean tumor size was 4.62 ± 1.66 mm in the EMR-C group and 7.73 ± 3.14 mm in the ESD group (P < 0.001). Endoscopic complete resection rate was 100% in both groups. Histologic complete resection rate was significantly greater in the EMR-C group (92.3%) than in the ESD group (78.4%) (P = 0.042). Mean procedure time was significantly longer in the ESD group (14.43 ± 7.26 min) than in the EMR-C group (3.83 ± 1.17 min) (P < 0.001). Rates of histologic complete resection without complication were similar for tumor diameter ≤ 5 mm (EMR-C, 96%; ESD, 100%, P = 0.472) as well as in cases of 5 mm < tumor diameter ≤ 10 mm (EMR-C, 80%; ESD, 71.0%, P = 0.524).

Conclusion: EMR-C may be simple, faster, and more effective than ESD in removing rectal NETs and may be preferable for resection of small rectal NETs.

Keywords: Complete resection; Complication; Endoscopic mucosal resection with cap; Endoscopic submucosal dissection; Neuroendocrine tumor.

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Figures

Figure 1
Figure 1
Endoscopic mucosal resection with a cap. A: Transparent cap is attached to the distal end of the scope; B: Saline solution with indigo-carmine solution is injected submucosally beneath the tumor; C: A crescent-shaped snare is positioned on the internal circumferential ridge; D: The submucosal layer is suctioned and dissected with the snare; E: A clear resection surface is observed; F: The resection specimen is retrieved and measured. EMR-C: Endoscopic mucosal resection with a cap.
See this image and copyright information in PMC

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