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. 2025 Aug 15:13:a26551320.
doi: 10.1055/a-2655-1320. eCollection 2025.

Optimal endoscopic resection method based on vertical margin distance for small rectal neuroendocrine tumors: Propensity score-matched study

Jianning Liu  1   2 , Weihua Yu  3 , Peng Liu  4 , Hao Tian  3 , Lihong Gan  4 , Kaige Zhang  4 , Hui Chen  3 , Nian Fang  1   4
Affiliations

Optimal endoscopic resection method based on vertical margin distance for small rectal neuroendocrine tumors: Propensity score-matched study

Jianning Liu et al. Endosc Int Open. .

Abstract

Background and study aims: Advanced endoscopic resection methods are recommended for removing rectal neuroendocrine tumors (NETs) < 10 mm, but there is no consensus on optimal endoscopic technique. This study aimed to determine whether endoscopic mucosal resection with ligation (EMR-L) is superior to endoscopic submucosal dissection (ESD) in terms of efficacy and safety, focusing on achieving adequate vertical margin distance.

Patients and methods: This dual-center cohort study included consecutive patients with rectal NETs ≤ 10 mm. Adequate vertical margins were exploratively defined as a margin distance exceeding 115 μm, the 25th percentile threshold. Propensity score matching (PSM) was applied to compare outcomes between EMR-L and ESD.

Results: The study included 204 rectal NETs from 186 patients, with 61 lesions in each group after PSM. Compared with ESD, the EMR-L group demonstrated a higher R0 resection rate (98.4% vs. 83.6%, P = 0.021), a greater proportion of adequate vertical margins (80.3% vs. 62.3%, P = 0.030), and a lower rate of positive vertical margins (1.6% vs. 13.1%, P = 0.041). Subgroup analysis indicated that lesions ≤ 5 mm without prior biopsy or central depression derived greater benefit from EMR-L. Furthermore, EMR-L was associated with significantly shorter procedure times (median 5.0 vs. 19 minutes) and a markedly lower overall complication rate (8.2% vs. 29.5%, P = 0.005), particularly perforation (3.3% vs. 16.4%, P = 0.028).

Conclusions: EMR-L outperforms ESD for small rectal NETs by achieving higher R0 and better vertical margins in shorter times, while minimizing risk of perforation.

Keywords: CRC screening; Endoscopic resection (polypectomy, ESD, EMRc, ...); Endoscopy Lower GI Tract; Polyps / adenomas / ....

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Conflict of interest statement

Conflict of Interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
a,b A 57-year-old female with a 5-mm rectal neuroendocrine tumor, located 5 cm from the anal verge, underwent endoscopic mucosal resection with ligation (EMR-L). The postoperative vertical margin was 1040 μm, meeting the adequate margin standard. c,d A 50-year-old female with a 4-mm rectal neuroendocrine tumor, located 8 cm from the anal verge, underwent endoscopic submucosal dissection (ESD). The postoperative vertical margin was 90 μm, failing to meet the adequate margin standard.
Fig. 2
Fig. 2
Flowchart of the study design. EMR-L, endoscopic mucosal resection with ligation; ESD, endoscopic submucosal dissection; NET, neuroendocrine tumor.
Fig. 3
Fig. 3
Subgroup analysis Forrest plot of adequate vertical margin distance before and after propensity score matching (PSM). CI, confidence interval; EMR-L, endoscopic mucosal resection with ligation; ESD, endoscopic submucosal dissection; OR, odds ratio. The ESD group is used as the reference group.
See this image and copyright information in PMC

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