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:
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.
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
Research background

Rectal carcinoid tumor is a clinically common submucosal tumor of the digestive tract. Lymph node metastasis risk of rectal carcinoid tumors less than 1 cm is low. Endoscopic local resection is currently the main treatment method, of which endoscopic submucosal dissection (ESD) is the first choice. Endoscopic mucosal resection (EMR) is also a commonly used treatment method for digestive tract mucosal lesions, with low technical requirements and relatively easy to grasp. Previous studies have shown that EMR also has a good effect on rectal carcinoids, but there is a residual risk of basal tumors, even with improved EMR (such as EMR-cap, EMR-P, C-EMR and so on). Therefore, it is of certain clinical value to explore a simple and effective method to treat small rectal carcinoids on the basis of EMR.

Research motivation

This study aimed to explore a simple and effective endoscopic resection method for the treatment of small rectal carcinoids, especially when ESD is not available.

Research objectives

The clinical application of ligation assisted endoscopic resection is extensive, especially for gastrointestinal submucosal tumors, and even the tumors less than 2 cm derived from the muscularis propria also can achieve satisfactory results. For some submucosal tumors that may have residual tumor in the basal part after endoscopic resection, the ligation method after endoscopic resection can lead to the final ischemic necrosis of the residual tumor and achieve the purpose of complete resection. The purpose of this study was to explore the efficacy of transparent cap assisted endoscopic mucosal resection combined with postoperative endoloop ligation in the treatment of rectal carcinoids.

Research methods

This study retrospectively analyzed the cases diagnosed as rectal carcinoid tumors and treated by ligation after cap (LC)-EMR or ESD in the gastroenterology unit of Shenzhen People’s Hospital between January 2016 and Decemeber 2017. Patients' demographic data, the complete resection rates, operation duration, and postoperative complications were collected.

Research results

A total of 34 patients including 24 males and 10 females with an average of 19-79 (47.47 ± 12.25) years participated in the study. The mean ages, tumor size, resection time, and pathologically complete resection (P-CR) rates of the ESD (n = 12) and LC-EMR (n = 22) groups were 48.18 ± 12.31 years vs 46.17 ± 12.57 years, 7.23 ± 1.63 mm vs 7.50 ± 1.38 mm, 15.67 ± 2.15 min vs 5.91 ± 0.87 min, and 91.67% (11/12) vs 86.36% (19/22), respectively. No perforation or delayed bleeding was observed in either group. Pathology diagnosis was confirmed as G1. Two of the three cases with a positive margin in the LC-EMR group received transanal rectal tumor resection 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. Both LC-EMR and ESD were effective methods to treat small rectal carcinoid tumors.

Research conclusions

LC-EMR appears to be an efficient and simple method for the treatment for small rectal carcinoid tumors less than 10 mm, especially when ESD is not available. LC-EMR can effectively prevent remnant tumors at the resection margin. Considering rectal carcinoid is a slow-growing tumor, long-term follow-up is necessary to determine the long- term efficacy of LC-EMR.

Research perspectives

To avoid local tumor residue after endoscopic resection, it is necessary to perform postoperative prophylactic endoloop ligation, even after ESD.