Factors Influencing Resection Time in Endoscopic Submucosal Dissection for Rectal Neuroendocrine Tumors

Abstract

Objectives: The usefulness of endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors (NETs) is well established. However, factors influencing resection time remain unclear. This study aimed to identify these factors during ESD for rectal NETs.

Methods: This retrospective study included 194 rectal NET lesions that were treated with ESD at our institution between March 2011 and July 2024. Potential factors influencing resection time-including age, sex, operator experience (non-expert endoscopist: <50 colorectal ESD cases), sodium hyaluronate use, traction device (TD) use, tumor location, lesion size, and specimen area-were analyzed using multiple regression analysis.

Results: The median resection time was 30 min (interquartile range [IQR]: 20-43 min). Non-expert endoscopists performed 53% of the procedures. The median specimen area was 302 mm² (IQR: 233-393 mm²). Resection time was significantly longer when procedures were performed by non-experts (β = 8.66; 95% confidence interval [CI]: 4.46-12.86; p <0.001), when the tumor was located in the upper rectum (Rs) compared to the lower rectum (Rb) (β = 20.96; 95% CI: 7.82-34.1; p = 0.002), and with increasing specimen area (β = 0.04; 95% CI: 0.027-0.06; p <0.001). Conversely, TD use significantly shortened resection time (β = -5.90; 95% CI: -11.37 to -0.43; p = 0.036).

Conclusions: Traction device use during ESD for rectal NETs is associated with shorter resection time; whereas, procedures performed by non-experts, tumors located in the Rs, and larger specimen areas were associated with longer resection time.

Keywords: endoscopic submucosal dissection; neuroendocrine tumor; procedure time; rectum; traction device.

FIGURE 1

Flow diagram of patient selection for the study. ESD, endoscopic submucosal dissection; NET, neuroendocrine tumor.

FIGURE 2

Step‐by‐step endoscopic submucosal dissection (ESD) of a rectal neuroendocrine tumor using a multi‐loop traction device. (a) Endoscopic view of a 7‐mm neuroendocrine tumor in the Ra segment of the rectum. (b) Marking dots placed circumferentially around the lesion. (c) Full circumferential mucosal incision prior to dissection, followed by the application of traction using a multi‐loop traction device. (d) Dissection phase assisted by the multi‐loop traction device. (e) Post‐ESD ulcer bed observed after complete resection. (f) Resected specimen after ESD. Ra, middle rectum.