Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2015; 21(31): 9387-9393
Published online Aug 21, 2015. doi: 10.3748/wjg.v21.i31.9387
Advantage of endoscopic mucosal resection with a cap for rectal neuroendocrine tumors
Su Bum Park, Hyung Wook Kim, Dae Hwan Kang, Cheol Woong Choi, Su Jin Kim, Hyeong Seok Nam
Su Bum Park, Hyung Wook Kim, Dae Hwan Kang, Cheol Woong Choi, Su Jin Kim, Hyeong Seok Nam, Department of Internal Medicine, Pusan National University School of Medicine and Research institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 626-770, South Korea
Author contributions: Kim HW designed the study; Park SB, Kim HW and Choi CW carried out the procedures; Kim SJ helped data collection; Nam HS and Kang DH analyzed the data and performed the statistical analysis; Park SB wrote the paper; Kang DH and Kim HW revised the article; all authors approved the final version of the paper.
Institutional review board statement: The study was reviewed and approved by the Pusan National University Yangsan Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at mdkhwook@gmail.com Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hyung Wook Kim, MD, PhD, Department of Internal Medicine, Pusan National University School of Medicine and Research institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do 626-770, South Korea. mdkhwook@gmail.com
Telephone: +82-55-360-1535 Fax: +82-55-360-1536
Received: January 22, 2015
Peer-review started: January 23, 2015
First decision: March 10, 2015
Revised: March 30, 2015
Accepted: May 7, 2015
Article in press: May 7, 2015
Published online: August 21, 2015
Processing time: 210 Days and 3 Hours
Abstract

AIM: To compare the outcomes of endoscopic mucosal resection with a cap (EMR-C) with those of endoscopic submucosal dissection (ESD) for the resection of rectal neuroendocrine tumors.

METHODS: One hundred and sixteen lesions in 114 patients with rectal neuroendocrine tumor (NET) resected with EMR-C or ESD were included in the study. This study was performed at Pusan National University Yangsan Hospital between July 2009 and August 2014. We analyzed endoscopic complete resection rate, pathologic complete resection rate, procedure time, and adverse events in the EMR-C (n = 65) and ESD (n = 51) groups. We also performed a subgroup analysis by tumor size.

RESULTS: Mean tumor size was 4.62 ± 1.66 mm in the EMR-C group and 7.73 ± 3.14 mm in the ESD group (P < 0.001). Endoscopic complete resection rate was 100% in both groups. Histologic complete resection rate was significantly greater in the EMR-C group (92.3%) than in the ESD group (78.4%) (P = 0.042). Mean procedure time was significantly longer in the ESD group (14.43 ± 7.26 min) than in the EMR-C group (3.83 ± 1.17 min) (P < 0.001). Rates of histologic complete resection without complication were similar for tumor diameter ≤ 5 mm (EMR-C, 96%; ESD, 100%, P = 0.472) as well as in cases of 5 mm < tumor diameter ≤ 10 mm (EMR-C, 80%; ESD, 71.0%, P = 0.524).

CONCLUSION: EMR-C may be simple, faster, and more effective than ESD in removing rectal NETs and may be preferable for resection of small rectal NETs.

Keywords: Neuroendocrine tumor; Endoscopic mucosal resection with cap; Endoscopic submucosal dissection; Complete resection; Complication

Core tip: This study suggests that rates of endoscopic and histologic complete resection without adverse events were high in endoscopic mucosal resection with a cap (EMR-C) for treating rectal neuroendocrine tumors (NETs). EMR-C seems to be a safe, easy, and effective method for the resection of rectal NETs because it is technically easier and less time-consuming than endoscopic submucosal dissection.