Related Experiment Video
Updated: Jan 27, 2026
A New Ex Vivo Model for the Evaluation of Endoscopic Submucosal Injection Material Performance
Published on: October 19, 2018
Incidental diagnosis of very small rectal neuroendocrine neoplasms: when should endoscopic submucosal dissection be
Nico Pagano1, Claudio Ricci1, Nicole Brighi2
1Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum-Università di Bologna, Bologna, Italy.
Purpose:
The management of small (≤5 mm) rectal neuroendocrine neoplasms (r-NENs), incidentally removed during colonoscopy, still remains under debate.
Methods:
All consecutive patients affected by r-NENs from January 2013 to December 2017 were studied. The inclusion criteria were: (1) patients having an incidental pathological diagnosis of very small (≤5 mm) polypoid r-NENs; (2) patients treated with a standard polypectomy as first-line therapy and (3) patients treated by endoscopic submucosal dissection (ESD) as salvage therapy. The primary endpoint was to identify the factors related to residual disease after a standard polypectomy. The secondary endpoint was to calculate the accuracy of endoscopic ultrasound (EUS), grading and size in predicting residual disease.
Results:
Starting from a prospective database of 123 consecutive patients affected by r-NENs, only 31 met the inclusion criteria. A final pathological examination of an ESD specimen showed residual disease in 7 out of 31 patients (22.6%). A multivariate analysis showed that the size of the polyps was the only independent factor related to residual disease with an odds ratio of 8.7 ± 7.5 (P = 0.013) for each millimetre. The accuracy of EUS, grading and tumour size (3.1 mm cut-off point) and area under the curves were 0.661 ± 0.111, 0.631 ± 0.109 and 0.821 ± 0.109, respectively.
Conclusions:
When the r-NEN polyp was larger than 3 mm, ESD was indicated. Unlike the size of the tumour, grading and EUS features did not accurately predict residual disease.
Insights
For small rectal neuroendocrine neoplasms (r-NENs) incidentally removed, polyp size is the key factor for residual disease. Endoscopic submucosal dissection (ESD) is recommended for polyps larger than 3 mm.
Area of Science:
- Gastroenterology
- Endocrinology
- Oncology
Background:
- Small rectal neuroendocrine neoplasms (r-NENs) are often incidentally found during colonoscopy.
- The optimal management strategy for these small r-NENs remains a subject of ongoing clinical debate.
Purpose of the Study:
- To identify factors predicting residual disease after standard polypectomy for small r-NENs.
- To evaluate the accuracy of endoscopic ultrasound (EUS), tumor grading, and size in predicting residual disease.
Main Methods:
- A retrospective analysis of 31 patients with incidentally diagnosed small (≤5 mm) r-NENs treated between 2013 and 2017.
- Patients underwent either standard polypectomy or endoscopic submucosal dissection (ESD) as salvage therapy.
- Multivariate analysis was used to determine predictors of residual disease.
Main Results:
- Residual disease was found in 22.6% of patients after ESD.
- Polyp size was the sole independent predictor of residual disease, with an odds ratio of 8.7 per millimeter increase.
- Tumor size (3.1 mm cutoff) demonstrated the highest accuracy (AUC 0.821) in predicting residual disease, outperforming EUS and grading.
Conclusions:
- For small rectal neuroendocrine neoplasms (r-NENs), polyp size is the critical factor in determining residual disease.
- Endoscopic submucosal dissection (ESD) is indicated for r-NENs larger than 3 mm.
- Tumor grading and EUS features are not reliable predictors of residual disease.
More Related Videos
05:57ADSC-sheet Transplantation to Prevent Stricture after Extended Esophageal Endoscopic Submucosal Dissection
Published on: February 10, 2017
03:13Author Spotlight: A Single-Entry Point Endoscopic Intraventricular Approach for Third Ventriculostomy and Pineal Biopsy
Published on: June 28, 2024
Related Concept Videos
01:27Assessing Body Temperature - Rectal
Follow these steps for rectal temperature assessment:
Step 1: Perform hand hygiene and don clean gloves to prevent cross-infection.
Step 2: Position the patient in a side-lying position to better visualize the rectal...
01:22Nursing Diagnosis
The nursing diagnosis focuses on evidence-based...
01:12What is an Experiment?
01:10Documentation of Nursing Diagnosis
In some settings, data-driven computerized decision support systems are in place, allowing for more accurate nursing diagnoses. The database within one of these systems includes diagnostic labels defining characteristics, activities, and indicators for nursing. A nurse enters...
03:20The Stanford Prison Experiment
01:26Formulating and Validating Nursing Diagnosis I
There are thirteen domains...