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Comparison of endoscopic therapies for rectal neuroendocrine tumors: endoscopic submucosal dissection with myectomy
Pinghu Sun1, Tuo Zheng1, Chunjiu Hu1
1Department of Gastroenterology, Ningbo First Hospital, Ningbo, 315000, Zhejiang, China.
Background:
Endoscopic submucosal dissection (ESD) has been a valuable treatment of choice for rectal neuroendocrine tumors (NETs). However, the vertical margin may remain positive after ESD because the neuroendocrine tumors develop in a submucosal tumor (SMT)-like way. Endoscopic submucosal dissection with myectomy (ESD-ME), a new method for rectal NETs, may overcome this problem.
Methods:
From August 2013 to August 2020, the medical records of 69 patients (72 rectal neuroendocrine tumors) who received endoscopic submucosal dissection (ESD) or endoscopic submucosal dissection with myectomy (ESD-ME) for rectal NETs were investigated retrospectively. The characteristics of the patients and tumors, the rate of complete resection, and the rate of complications were analyzed retrospectively.
Results:
The ESD-ME group contained 27 patients (12 males, 15 females; age range 29-72 years) and the ESD group contained 42 patients (21 males, 21 females; age range 29-71 years). Both groups had similar mean rectal neuroendocrine tumor diameters (ESD-ME 6.1 ± 1.8 mm, ESD 6.7 ± 2.6 mm; P = 0.219). The procedure time was not different significantly between groups (ESD-ME 21.1 ± 6.3, ESD 19.3 ± 3.1; P = 0.115). The endoscopic complete resection rate did not differ significantly between the ESD-ME and ESD groups (100% for each). The histological complete resection rate was 100% (27 of 27) in the ESD-ME group and 81.0% (34 of 42) in the ESD group (P = 0.043). Delayed bleeding occurred in 1 ESD-ME patient (3.7%) and in 2 ESD patients (4.8%) (P = 1.000). Perforation occurred in 1 ESD-ME patient (3.7%) and the patient was successfully managed by conservative measure, and there was no perforation after ESD (P = 0.391).
Conclusions:
When compared with ESD, ESD-ME resulted in a higher histological complete resection rate, had a similar complication rate, and took similar time to perform. ESD-ME can be considered an effective and safe resection method for rectal NETs < 16 mm in diameter without metastasis.
