Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2019; 25(10): 1259-1265
Published online Mar 14, 2019. doi: 10.3748/wjg.v25.i10.1259
Endoloop ligation after endoscopic mucosal resection using a transparent cap: A novel method to treat small rectal carcinoid tumors
Ding-Guo Zhang, Su Luo, Feng Xiong, Zheng-Lei Xu, Ying-Xue Li, Jun Yao, Li-Sheng Wang
Ding-Guo Zhang, Su Luo, Feng Xiong, Zheng-Lei Xu, Ying-Xue Li, Jun Yao, Li-Sheng Wang, Department of Gastroenterology, Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen 518020, Guangdong Province, China
Author contributions: Luo S, Xu ZL, and Li YX contributed to study conception and design; Zhang DG and Xiong F contributed to data acquisition, analysis, and interpretation, and writing of the article; Yao J and Wang LS contributed to editing, reviewing, and final approval of the article.
Institutional review board statement: This study was approved by the institutional review board of Shenzhen People’s Hospital.
Informed consent statement: Informed consent was obtained from each patient.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
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/
Corresponding author: Jun Yao, MD, Associate Professor, Doctor, Department of Gastroenterology, Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, 1017 East Gate Road, Shenzhen 518020, Guangdong Province, China. yao.jun@szhospital.com
Telephone: +86-755-22943300 Fax: +86-755-25533497
Received: January 13, 2019
Peer-review started: January 14, 2019
First decision: January 23, 2019
Revised: January 29, 2019
Accepted: January 30, 2019
Article in press: January 30, 2019
Published online: March 14, 2019
Processing time: 61 Days and 16.9 Hours
Abstract
BACKGROUND

Local endoscopic resection is an effective method for the treatment of small rectal carcinoid tumors, but remnant tumor at the margin after resection remains to be an issue.

AIM

To evaluate the efficacy and safety of resection of small rectal carcinoid tumors by endoloop ligation after cap-endoscopic mucosal resection (LC-EMR) using a transparent cap.

METHODS

Thirty-four patients with rectal carcinoid tumors of less than 10 mm in diameter were treated by LC-EMR (n = 22) or endoscopic submucosal dissection (ESD) (n = 12) between January 2016 and December 2017. Demographic data, complete resection rates, pathologically complete resection rates, operation duration, and postoperative complications were collected. All cases were followed for 6 to 30 mo.

RESULTS

A total of 22 LC-EMR cases and 12 ESD cases were enrolled. The average age was 48.18 ± 12.31 and 46.17 ± 12.57 years old, and the tumor size was 7.23 ± 1.63 mm and 7.50 ± 1.38 mm, respectively, for the LC-EMR and ESD groups. Resection time in the ESD group was longer than that in the LC-EMR group (15.67 ± 2.15 min vs 5.91 ± 0.87 min; P < 0.001). All lesions were completely resected at one time. No perforation or delayed bleeding was observed in either group. Pathologically complete resection (P-CR) rate was 86.36% (19/22) and 91.67% (11/12) in the LC-EMR and ESD groups (P = 0.646), respectively. Two of the three cases with a positive margin in the LC-EMR group received transanal endoscopic microsurgery (TEM) and tumor cells were not identified in the postoperative specimens. The other case with a positive margin chose follow-up without further operation. One case with remnant tumor after ESD received further local ligation treatment. Neither local recurrence nor lymph node metastasis was found during the follow-up period.

CONCLUSION

LC-EMR appears to be an efficient and simple method for the treatment of small rectal carcinoid tumors, which can effectively avoid margin remnant tumors.

Keywords: Rectal carcinoid; Endoscopic submucosal dissection; Endoscopic mucosal resection; Ligation

Core tip: Rectal carcinoid is a common clinical submucosal tumor of the digestive tract. Small rectal carcinoids rarely have lymph node metastasis or distant metastasis, and local endoscopic resection is an effective method for the treatment of small rectal carcinoid tumors, but remnant tumor at the margin after resection remains to be an issue. Endoloop ligation after cap-endoscopic mucosal resection using a transparent cap appears to be an efficient and simple method for the treatment of small rectal carcinoid tumors, which can effectively avoid margin remnant tumors.