Endoscopic treatments for rectal neuroendocrine tumors: a systematic review and network meta-analysis

Conventional endoscopic mucosal resection (cEMR), EMR with a transparent cap, EMR using a ligation device (EMR-L), EMR after circumferential precutting (EMR-P), and endoscopic submucosal dissection (ESD) have been used for resecting rectal neuroendocrine tumors (r-NETs). However, there is no consensus regarding which is the best treatment. This study aimed to compare the outcomes of the aforementioned 5 techniques for resecting r-NETs by network meta-analysis.

Electronic databases (PubMed, Cochrane Library, Embase, Ovid Medline, and Web of Science) were systematically searched to include relevant studies published from inception to September 1, 2023. The en bloc resection rate, histologic complete resection rate, positive lateral margin rate, positive vertical margin rate, adverse events rate, and procedure time were compared.

A total of 27 studies with a total of 2112 r-NETs were included, and the mean diameter of tumors was 6.24 mm. Pairwise meta-analysis showed that EMR-L and ESD had higher en bloc resection and histologic complete resection rates and lower positive vertical margin rate than those of cEMR in resecting r-NETs. Compared with ESD, EMR-L and EMR-P achieved similar resection rates and significantly shortened the procedure time without increasing adverse events. The network meta-analysis evaluated the surface under the cumulative ranking curves and revealed that EMR-L was the best modality for treating r-NETs considering the comprehensive results of the en bloc resection rate, histologic complete resection rate, positive lateral margin rate, positive vertical margin rate, adverse events rate, and procedure time.

EMR-L should be recommended as the first-line endoscopic treatment for small r-NETs.