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Published on: February 12, 2022
Current status of endoscopic resection for small rectal neuroendocrine tumors
Jian-Ning Liu1, Hui Chen2, Nian Fang1,3
1Department of Gastroenterology, The Third Affiliated Hospital, Jiangxi Medical College, School of Queen Mary, Nanchang University, Nanchang 330009, Jiangxi Province, China.
Abstract:
Rectal neuroendocrine tumor (rNET) is an indolent malignancy often detected during colonoscopy screening. The incidence of rNET has increased approximately 10-fold over the past 30 years. Most rNETs detected during screening endoscopy are small, measuring < 10 mm. Current guidelines recommend endoscopic resection for small, well-differentiated rNET using modified endoscopic submucosal resection (mEMR) or endoscopic submucosal dissection. However, the optimal endoscopic treatment method remains uncertain. This paper summarizes the evidence on mEMR with submucosal stretching, mEMR without submucosal stretching, endoscopic submucosal dissection and endoscopic full-thickness resection. Given that rNETs often exhibit submucosal invasion, achieving adequate resection depth is crucial to ensure histological complete resection. mEMR with submucosal stretching appears favorable due to its high rate of histological complete resection, safety and convenience. Risk factors associated with lymph node and distant metastases are also discussed. A treatment algorithm is proposed to facilitate clinical decision-making.
Insights
Rectal neuroendocrine tumors (rNETs) are increasingly detected during screening. Modified endoscopic submucosal resection with submucosal stretching offers a favorable option for complete resection of small rNETs.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Endoscopic Therapeutics
Background:
- Rectal neuroendocrine tumors (rNETs) are indolent malignancies with a 10-fold increased incidence over 30 years.
- Most detected rNETs are small (<10 mm) and found during colonoscopy screening.
- Current guidelines suggest endoscopic resection, but optimal methods are debated.
Purpose of the Study:
- To summarize evidence on endoscopic resection techniques for rNETs.
- To evaluate the efficacy and safety of different endoscopic modalities.
- To propose a treatment algorithm for clinical decision-making.
Main Methods:
- Review of evidence on modified endoscopic submucosal resection (mEMR) with and without submucosal stretching.
- Evaluation of endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFTR).
- Analysis of risk factors for lymph node and distant metastases.
Main Results:
- Achieving adequate resection depth is critical due to submucosal invasion in rNETs.
- mEMR with submucosal stretching demonstrated a high rate of histological complete resection.
- This technique also showed favorable safety and convenience profiles.
Conclusions:
- Modified endoscopic submucosal resection with submucosal stretching is a promising treatment for rNETs.
- The technique ensures histological complete resection with good safety.
- A proposed algorithm aids in clinical decision-making for rNET management.
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