Comparison between cap-assisted and ligation-assisted endoscopic mucosal resection for rectal neuroendocrine tumors

Jin Lee; Yong Eun Park; Joon Hyuk Choi; Nae-Yun Heo; Jongha Park; Seung Ha Park; Young Soo Moon; Kyung Han Nam; Tae Oh Kim

Authors Jin Lee, Yong Eun Park, Joon Hyuk Choi, Nae-Yun Heo, Jongha Park, Seung Ha Park, Young Soo Moon, Kyung Han Nam, Tae Oh Kim.

Abstract

Background Modified endoscopic mucosal resection (EMR) is considered a treatment option for rectal neuroendocrine tumors (NETs) <10 mm in diameter. In this study, we evaluated the clinical outcomes of cap-assisted EMR (EMR-C) and EMR with a ligating device (EMR-L).

Methods We retrospectively analyzed 158 patients with 162 rectal NETs treated endoscopically at a single Korean tertiary hospital between March 2010 and November 2017. We evaluated the rates of endoscopic en bloc resection, histologic complete resection, and procedural complications according to the treatment method.

Results Among 162 rectal NETs, 42 were treated with EMR-C and 120 with EMR-L. The endoscopic en bloc resection rate was higher in the EMR-L group than in the EMR-C group (100% vs. 92.9%, P=0.003). A trend was observed towards a superior histologic complete resection rate in the EMR-L group, but it was not statistically significant (92.5% vs. 83.3%, P=0.087). There were no significant differences in procedural complications (P=0.870). In a multivariate analysis, a tumor located ≥10 cm from the anal verge was related to histologic incomplete resection (P=0.039).

Conclusion EMR-L may be the preferable treatment method, considering both endoscopic en bloc resection rate and histologic complete resection rate.

Keywords Rectal neuroendocrine tumor, endoscopic mucosal resection-ligating device, capassisted

Ann Gastroenterol 2020; 33 (4): 385-390