Endoscopic mucosal resection with suction vs. endoscopic submucosal dissection for small rectal neuroendocrine tumors: a meta-analysis

Pan, Jianmei; Zhang, Xiaohua; Shi, Yumeng; Pei, Qingshan

doi:10.1080/00365521.2018.1498120

Cited by 37 publications

(38 citation statements)

References 29 publications

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“…In our retrospective dataset, both the en bloc and complete resection rates of ASEMR were not significantly different from those of EMR-C. Compared with the complete resection rate of EMR-C for small NETs found in our previous report (94.1%) 13 , and the pooled complete resection rate of EMR with suction methods for small NETs reported in a meta-analysis (93.7%) 15 , the complete resection rate of ASEMR for rectal NETs found in the current study seems acceptable. According to an earlier report on the ASEMR technique, the provision of gentle pressure toward the anchoring point helps the snare widen laterally while snaring and contributes to acquisition of a larger specimen size 18 .…”

Section: Discussioncontrasting

confidence: 61%

“…Our previous study on small rectal NETs indicated that EMR-C required a shorter procedure time than ESD, while the therapeutic efficacy and safety profiles did not significantly differ between the two procedures 13 . Furthermore, a recent meta-analysis suggested that EMR with suction (EMR-C or EMR-L) was superior to ESD for complete removal of small rectal NETs 15 . However, EMR with suction techniques requires specialized devices, such as a band ligation device for EMR-L and a suction cap with inner rim looped by a crescent-type snare for EMR-C. As these devices are essential for each procedure, endoscopists and assistants need to spend additional time and effort on applying the devices to the scope.…”

Section: Introductionmentioning

confidence: 99%

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Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors

Kim

et al. 2021

Sci Rep

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Small rectal neuroendocrine tumors (NETs) can be treated using cap-assisted endoscopic mucosal resection (EMR-C), which requires additional effort to apply a dedicated cap and snare. We aimed to evaluate the feasibility of a simpler modified endoscopic mucosal resection (EMR) technique, so-called anchored snare-tip EMR (ASEMR), for the treatment of small rectal NETs, comparing it with EMR-C. We retrospectively evaluated 45 ASEMR and 41 EMR-C procedures attempted on small suspected or established rectal NETs between July 2015 and May 2020. The mean (SD) lesion size was 5.4 (2.2) mm and 5.2 (1.7) mm in the ASEMR and EMR-C groups, respectively (p = 0.558). The en bloc resection rates of suspected or established rectal NETs were 95.6% (43/45) and 100%, respectively (p = 0.271). The rates of histologic complete resection of rectal NETs were 94.1% (32/34) and 88.2% (30/34), respectively (p = 0.673). The mean procedure time was significantly shorter in the ASEMR group than in the EMR-C group (3.12 [1.97] vs. 4.13 [1.59] min, p = 0.024). Delayed bleeding occurred in 6.7% (3/45) and 2.4% (1/41) of patients, respectively (p = 0.618). In conclusion, ASEMR was less time-consuming than EMR-C, and showed similar efficacy and safety profiles. ASEMR is a feasible treatment option for small rectal NETs.

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Section: Discussioncontrasting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors

Kim

et al. 2021

Sci Rep

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“…Remarkably, R0 rates (89.5 % -94.1 %) were similar between mEMR and ESD [11,12]. In contrast, a recent meta-analysis showed that mEMR (with suction) is superior to ESD for small rectal NETs (≤ 10 mm) in terms of histological complete resection and procedure time [13].…”

Section: Discussionmentioning

confidence: 94%

Full-thickness resection of neuroendocrine tumors in the rectum

et al. 2019

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Background Rectal neuroendocrine tumors (NETs) are subepithelial tumors with potential for malignancy. Depending on tumor characteristics, endoscopic or surgical resection is recommended. However, the optimal endoscopic approach is not defined. This is the first larger study evaluating endoscopic full-thickness resection (EFTR) of rectal NETs. Methods For resection, the full-thickness resection device (FTRD) was used. A registry was created as part of post-market clinical follow-up. All cases of rectal NETs in the registry were analyzed retrospectively. Results 31 German centers entered data of 501 FTRD procedures and 40 cases of rectal NETs were identified. The median lesion size was 8 mm. All lesions could be resected using FTRD. The median procedure time was 18.5 minutes. Resection was macroscopically and histologically complete in all cases. Full-thickness resection was achieved in 95 %. No major adverse events occurred. Endoscopic follow-up showed no evidence of residual or recurrent tumor. Conclusion EFTR is safe and effective for resection of smaller rectal NETs. Prospective comparative trials are needed to define the role of EFTR of rectal NETs.

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“…Several studies on rectal NETs showed that the complete resection rate was significantly higher after ESD relative to simple EMR but was comparable to modified EMR (EMR with banding or using a cap and suction) [ 19 , 28 ]. Surprisingly, other studies, including a meta-analysis on 14 studies and 823 cases, concluded that modified EMR with the suction method (93.65%) is superior to ESD (84.08%) in achieving free resection margins in rectal NETs smaller than 10 mm [ 29 – 31 ]. The modified EMR (m-EMR) technique using either suction cap or ligation band is much more effective in achieving complete resection and R0 margin comparing to conventional EMR procedure which is performed by a snare after submucosal saline injection [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic mucosal resection: still a reliable therapeutic option for gastrointestinal neuroendocrine tumors

et al. 2021

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Background Neuroendocrine tumors (NETs), as a rare and heterogeneous category of solid tumors, feature various morphologies and behaviors. In recent years, the incidence of NETs has continued to increase. Endoscopic mucosal resection (EMR) is one of the therapeutic modalities for the treatment of gastric and rectal NETs. Methods We evaluated patients with well-differentiated NETs of the stomach, duodenum, or rectum between 2011 and 2018. In this study, all cases with tumors confined to the mucosal or submucosal layers and smaller than 20 mm were resected using the EMR technique. We used EUS, CT scan, or MRI to exclude patients with advanced disease. All patients were actively monitored for recurrence according to the recommended protocols. Results A total of 36 patients with NETs entered the study; 17 (47.2%) were female and the remaining 19 (52.8%) were male, with a total age range of 20–74 years (mean: 52.47 ± 13.47 years). Among the tumors, 31 cases (86.1%) were G1 and the remaining 5 (13.9%) were G2. Based on the pathology reports, 22 tumors (61.1%) were smaller than 1 cm, while the remaining 14 (38.9%) were between 1–2 cm. Twenty-two patients (61.1%) had a margin of specimen involved with the tumor. No recurrence was observed during the mean follow-up time of 63.5 ± 19.8 months (range: 39–103 months). All 36 cases survived during the study period. Conclusion Conventional EMR procedure provides low chance of R0 (complete resection) achievement in gastrointestinal NETs smaller than 20 mm and limited to the mucosa or sub mucosa. However, it could be an option if patients are closely followed. Postoperative marginal involvement is not a reliable predictor of disease recurrence, which may be explained by the deleterious effect of heat coagulation and cauterization applied during tumor removal.

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Endoscopic mucosal resection with suction vs. endoscopic submucosal dissection for small rectal neuroendocrine tumors: a meta-analysis

Abstract: The present meta-analysis mostly based on retrospective studies show that EMR with suction is superior to ESD for small rectal NETs (≤10 mm) with higher complete resection rate, shorter procedure time, and similar overall complication rate and recurrence.

Cited by 37 publications

References 29 publications

Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors

Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors

Full-thickness resection of neuroendocrine tumors in the rectum

Endoscopic mucosal resection: still a reliable therapeutic option for gastrointestinal neuroendocrine tumors

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