Endoscopic treatment of rectal neuroendocrine tumors in a 13-year retrospective single-center study. Are we following the guidelines?

Abstract

INTROduCTIONRectal neuroendocrine neoplasms (rNENs) are small tumors that are currently being found at an increasing frequency during colonoscopy examinations. 1 These are usually G1 lesions, of less than 10 mm in diameter, derived from the muscularis mucosa, which grow into the submucosa and deeper layers. Their subepithelial origin is the reason why simple snare or biopsy forcep polypectomy is usually an ineffective method of treatment. Thus, more advanced methods such as endoscopic mucosal resection

Management & surveillance of rectal neuroendocrine tumours: a single‐centre retrospective analysis

“…Although the link could not be demonstrated in this study, other studies with larger sample sizes have demonstrated a definitive link between advanced endoscopic techniques and increased likelihood of R0 resection. 8,9,[14][15][16] When R0 resection is not achieved with the first procedure, repeated interventions are necessary which increases the risk of complications, patient distress and further economic burden. Overall, this highlights the need for increased endoscopist education regarding recognition of rNETs, appropriate choice of endoscopic resection technique and consideration of referral to specialist centres.…”

“…Standard polypectomy without lifting may be insufficient due to the subepithelial origin of these lesions, there is evidence for advanced endoscopic techniques including endoscopic submucosal dissection (ESD) and cap-assisted mucosal resection. 1,2,4,[8][9][10][11][12][13][14][15][16] Post endoscopic excision of rNETs, ENETS underscores the importance of distinguishing lesions based on their pathological status; be it R0, indeterminate, or R1 (any margin, even a free margin <1 mm is defined as R0). They advise that every attempt should be made to render indeterminate or R1 resected lesions R0 to reduce recurrence risk and allow for follow-up based on the R0 resection category (i.e., no follow-up for lesions <10 mm without risk factors).…”

“…Lesion recognition and appropriate resection technique is required for successful excision. Standard polypectomy without lifting may be insufficient due to the subepithelial origin of these lesions, there is evidence for advanced endoscopic techniques including endoscopic submucosal dissection (ESD) and cap‐assisted mucosal resection 1,2,4,8–16 …”

Colorectal neuroendocrine neoplasms — update of the diagnostic and therapeutic guidelines (recommended by the Polish Network of Neuroendocrine Tumours) [Nowotwory neuroendokrynne jelita grubego — uaktualnione zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)]

“…However, in clinical practice, the correct diagnosis of RNENs at the time of the first endoscopy concerns only 18-30% of patients. Most lesions are removed incorrectly and non-radically, using a diathermy loop or biopsy forceps -the R0 resection rate is 24-30% [24,82]. It may also occur that the correct endoscopic method of NEN treatment is used but R0 resection is not achieved.…”

“…Jednak w praktyce klinicznej prawidłowe rozpoznanie RNEN w czasie pierwszej endoskopii dotyczy jedynie 18-30% pacjentów. Większość zmian jest nieprawidłowo i nieradykalnie usuwana, za pomocą pętli diatermicznej lub kleszczyków biopsyjnych -odsetek resekcji R0 wynosi 24-30% [24,82]. Może też wystąpić sytuacja, w której do leczenia endoskopowego NEN zastosowano technikę prawidłową, ale nie uzyskano resekcji R0.…”