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UNDERWATER ENDOSCOPIC MUCOSAL RESECTION FOR SMALL RECTAL NEUROENDOCRINE TUMORS
Lara Meireles Azeredo Coutinho1, Luciano Lenz1,2, Fabio S Kawaguti1,2
1Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Serviço de Endoscopia, São Paulo, SP, Brasil.
Arquivos De Gastroenterologia
|June 16, 2021
Summary
Underwater endoscopic mucosal resection (UEMR) is a safe and effective treatment for small rectal neuroendocrine tumors (rNETs). This technique achieved high en bloc and R0 resection rates with no adverse events in a recent study.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Oncology
Background:
- Rectal neuroendocrine tumors (rNETs) are common.
- Endoscopic mucosal resection (EMR) with saline injection is standard but struggles with deep margins due to common submucosal invasion.
- Underwater endoscopic mucosal resection (UEMR) eliminates the need for submucosal lifting by filling the lumen with water.
Purpose of the Study:
- To evaluate the efficacy and safety of UEMR for small rNET removal.
- To assess UEMR's effectiveness in achieving complete tumor resection.
Main Methods:
- Retrospective analysis of 11 patients undergoing UEMR for small rNETs across two centers.
- Standard colonoscope used; no submucosal injection performed.
- Histopathologic assessment by board-certified pathologists.
Main Results:
- 11 small rNETs (mean size 7 mm) removed en bloc from 11 patients (mean age 55.8 years).
- 81% of resections had free margins (R0); two had deep margin involvement.
- No perforations or delayed bleeding observed; UEMR demonstrated high en bloc and R0 resection rates.
Conclusions:
- UEMR is a safe and effective alternative for treating small rNETs.
- High en bloc and R0 resection rates were achieved with UEMR.
- Further prospective studies are needed to compare endoscopic techniques for rNET resection.
