Efficacy of Endoscopic Submucosal Resection With a Ligation Device for Removing Small Rectal Carcinoid Tumor Compared With Endoscopic Mucosal Resection: Analysis of 100 Cases

Abstract

ESMR-L is a significantly superior modality to EMR for the complete removal of small rectal carcinoid tumors that are 10 mm or less in diameter.

Rectal carcinoids: a systematic review

“…The recent metaanalysis by Zhong et al concluded that tumours up to 16mm operated with ESD had low recurrence rates and comparable complication rates with EMR [13]. It has been previously published that tumours greater than 20mm should have radical surgery [33] and currently the literature regarding endoscopic management of rectal carcinoids does not detail any attempts in tumours greater than this size [13,[18][19][20].…”

“…In fact, only 1633/4575 (36%) had accurate staging recorded. 3 studies analysed a selected group of tumours up to the submucosa and are recorded in Table 3 but are not analysed [18][19][20]. 1260/1418 (89%) tumours were confined to the submucosa, 5% invaded the muscularis propria and 6% were beyond the muscularis propria.…”

“…Therefore, there were 14 papers evaluated in this review. All 14 papers scored low to moderate on quality assessment with a range of 9 -17 out of a possible 27 [9] (see Table 1 Demographics and tumour size This paper excluded case series with less than 100 patients; the smallest series included had 100 patients and the largest was from registry data with 1481 patients (see table 1) [7,19]. The total number of patients from all studies was 4575.…”

Frequent Presence of Lymphovascular Invasion in Small Rectal Neuroendocrine Tumors on Immunohistochemical Analysis

“…Therefore, recent guidelines recommend additional treatment for RNETs if LVI is presented after ER [10,17]. Previous studies have shown that small RNETs have a very low incidence of LVI [18,19,20,21]. Nonetheless, in our clinical practice, LVI has often been detected using immunohistochemical analysis in addition to hematoxylin-eosin (HE) staining.…”

Efficacy of Endoscopic Mucosal Resection after Circumferential Mucosal Incision of Small Rectal Carcinoid Tumors

“…For submucosal lesions such as rectal carcinoid tumors, endoscopic treatment with a special technique for deeper resection to achieve clear margins has been reported: endoscopic submucosal resection with a ligation device (ESMR-L) or EMR with a ligation device (EMR-L), for which ligation devices were used before resection, enables deeper vertical resection margins to be achieved [31][32][33][34]. EMR with a cap (EMR-C) uses a transparent cap and suction to excise the submucosal layer to ensure a safe vertical margin [35][36][37].…”