Comparison of conventional and modified endoscopic mucosal resection methods for the treatment of rectal neuroendocrine
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and Other Interventional Techniques
Comparison of conventional and modified endoscopic mucosal resection methods for the treatment of rectal neuroendocrine tumors Hee Sung Lee1 · Hee Seok Moon1 · In Sun Kwon2 · Jae Ho Park1 · Ju Seok Kim1 · Sun Hyung Kang1 · Eaum Seok Lee1 · Seok Hyun Kim1 · Jae Kyu Sung1 · Byung Seok Lee1 · Hyun Yong Jeong1 Received: 9 April 2020 / Accepted: 13 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background/aim Small rectal neuroendocrine tumors (NETs) confined to the submucosa are endoscopically resectable. Because most rectal NETs are submucosal tumors, conventional endoscopic mucosal resection (cEMR) may not result in a complete resection. This study investigated whether modified EMRs, namely endoscopic submucosal resection with ligation (ESMR-L), EMR with precutting (EMR-P), and strip biopsy are superior to cEMR for achieving histologically complete resection (HCR) of rectal NETs. Methods Medical records of 215 patients who were treated with endoscopic resections for rectal NETs between January 2011 and July 2019 were retrospectively enrolled. Of the patients, 110, 33, 29, and 43 underwent cEMR, ESMR-L, EMR-P, and strip biopsy, respectively. For each method, HCR and en bloc resection rates, procedure times, and complication rates were measured. Results HCR was achieved with cEMR, EMR-P, ESMR-L, and strip biopsies for 74.5%, 90.9%, 93.1%, and 90.7% of cases, respectively. The HCR rate for cEMR was inferior to those of the modified EMRs (p = 0.045 for cEMR vs. EMR-P; p = 0.031 for cEMR vs. ESMR-L; p = 0.027 for cEMR vs. strip biopsy). Among the three modified EMRs, there was no significant difference in achieving HCR (p = 1.000). En bloc resection (p = 0.096) and complication rates (p = 0.071) were not significantly different among the four EMR methods, although EMR-P required the longest procedure time (p = 0.000). Conclusions All three modified EMRs are superior to cEMR and are equally effective for achieving HCR of rectal NETs. Keywords Rectal neuroendocrine tumor · Modified endoscopic mucosal resection · Complete resection Neuroendocrine tumors (NETs) are a diverse group of neoplasms that can develop anywhere in the body where neuroendocrine cells are present [1, 2]. Neuroendocrine cells are widely distributed throughout the gastrointestinal (GI) tract, making GI organs the most common site of NET development; GI-NETs comprise 62–67% of all NETs [3, 4]. The rectum is the most prevalent anatomical site for NETs, and the incidence of rectal NETs increased nine-fold during
* Hee Seok Moon [email protected] 1
Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa‑ro, Jung‑gu, Daejeon 35015, South Korea
Clinical Trials Center, Chungnam National University Hospital, Daejeon 35015, South Korea
2
1993–2013 due to the growing number of screening colonoscopies [5, 6]. Although most rectal NETs achieve favorable clinical
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