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Hamada Y, Tanaka K, Mukai K, Baba Y, Kobayashi M, Tominaga S, Kawabata H, Sawai S, Kaneko M, Sugimoto S, Inoue H, Mimuro M, Tamaru S, Nakagawa H. Efficacy of Endoscopic Resection for Rectal Neuroendocrine Tumors Smaller than 15 mm. Dig Dis Sci 2023:10.1007/s10620-023-07914-4. [PMID: 37024740 DOI: 10.1007/s10620-023-07914-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/02/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Local resection, including endoscopic resection, is recommended for rectal neuroendocrine tumors (NETs) < 15 mm in patients without risk factors for metastasis, though the short- and long-term outcomes are unclear. AIMS This study investigates the efficacy of endoscopic resection for rectal NETs < 15 mm. METHODS The short- and long-term outcomes of patients with rectal NETs < 15 mm who underwent endoscopic resection and the outcomes of each endoscopic technique were analyzed. The tumors were stratified as < 10 mm (small-size group, SSG) and 10-14 mm (intermediate-size group, IMG). RESULTS Overall, 139 lesions (SSG, n = 118; IMG, n = 21) were analyzed. All tumors were classified as G1 (n = 135) or G2 (n = 4) according to the 2019 World Health Organization grading criteria. The complete resection rate was not different between the groups (P = 0.151). Endoscopic submucosal dissection (ESD) and endoscopic submucosal resection with a ligation device (ESMR-L) achieved complete resection rates > 90% in the SSG. The ESMR-L procedure time (P < 0.001) and hospitalized period (P < 0.001) were significantly shorter than those of ESD. ESD achieved a complete resection rate of 80.0% in the IMG. The tumor size did not affect the overall survival or rate of lymph node/distant metastases. CONCLUSIONS Endoscopic resection is a feasible and effective treatment for patients with rectal NETs < 15 mm without the risk factors of metastasis. ESMR-L and ESD are optimal techniques for resecting tumors smaller than 10 mm and 10-14 mm, respectively.
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Affiliation(s)
- Yasuhiko Hamada
- Department of Gastroenterology and Hepatology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Kyosuke Tanaka
- Department of Gastroenterology and Hepatology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
- Department of Endoscopy, Mie University Hospital, Tsu, Japan.
| | - Katsumi Mukai
- Department of Gastroenterology, Suzuka General Hospital, Suzuka, Japan
| | - Youichirou Baba
- Department of Pathology, Suzuka General Hospital, Suzuka, Japan
| | - Makoto Kobayashi
- Department of Gastroenterology, Municipal Yokkaichi Hospital, Yokkaichi, Japan
| | - Shintaro Tominaga
- Department of Gastroenterology, Municipal Yokkaichi Hospital, Yokkaichi, Japan
| | - Hiroyuki Kawabata
- Department of Gastroenterology, Saiseikai Mastusaka General Hospital, Matsusaka, Japan
| | - Shoma Sawai
- Department of Gastroenterology, Saiseikai Mastusaka General Hospital, Matsusaka, Japan
| | - Masabumi Kaneko
- Department of Gastroenterology, Matsusaka General Hospital, Matsusaka, Japan
| | - Shinya Sugimoto
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Hidekazu Inoue
- Department of Gastroenterology, Mie Prefectural Medical Center, Yokkaichi, Japan
| | - Maya Mimuro
- Department of Oncologic Pathology, Mie University Hospital, Tsu, Japan
| | - Satoshi Tamaru
- Department of Clinical Research Center, Mie University Hospital, Tsu, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology and Hepatology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Luo PP, Ou XL. Endoscopic mucosal dissection for multiple rectal carcinoids: A case report. Shijie Huaren Xiaohua Zazhi 2022; 30:1004-1008. [DOI: 10.11569/wcjd.v30.i22.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Multiple rectal carcinoids have a low incidence clinically. Curative resection can be achieved by endoscopy, but there is a risk of missing the lesion. Postoperative follow-up is very important.
CASE SUMMARY A patient was diagnosed with multiple rectal carcinoids and hemorrhoids by colonoscopy due to repeated hematochezia for more than 2 mo. After chest, abdominal and pelvic contrast-enhanced CT examinations were completed to exclude carcinoid metastasis, endoscopic lesion resection was performed. A total of eight lesions were completely removed. Postoperative pathology and immunohistochemistry confirmed carcinoids, classified as G1. No new lesions were found by colonoscopy 3 mo after operation.
CONCLUSION For multiple rectal carcinoids smaller than 1 cm, endoscopic dissection can be curative, but close follow-up should be performed.
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Affiliation(s)
- Pei-Pei Luo
- Department of Gastroenterology, Wujin People's Hospital Affiliated to Jiangsu University, Changzhou 213000, Jiangsu Province, China
| | - Xi-Long Ou
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China
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3
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Comparison between endoscopic mucosal resection with a cap and endoscopic submucosal dissection for rectal neuroendocrine tumors. BMC Surg 2022; 22:248. [PMID: 35761304 PMCID: PMC9238094 DOI: 10.1186/s12893-022-01693-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study is to evaluate and compare the safety and efficacy of endoscopic mucosal resection with a cap (EMR-c) with those of endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors (R-NETs) ≤ 15 mm in diameter, and to analyze the risk factors of incomplete resection. Methods A total of 122 patients who underwent EMR-c or ESD for R-NETs at the Fourth Hospital of Hebei Medical University between February 2007 and December 2020 were invovled in this study. The clinical outcomes of two groups were compared and evaluated. Results A total of 122 patients with 128 R-NETs underwent endoscopic resection (EMR-c, 80; ESD, 48). In terms of duration of operation, EMR-c was significantly shorter than ESD (p < 0.001). Univariate analysis and multivariate analysis suggested that tumor diameter ≥ 8 mm was an independent risk factor for incomplete resection in patients with R-NETs in this study. Conclusions Both EMR-c and ESD were safe and effective treatments for R-NETs ≤ 15 mm in diameter. In addition, tumor diameter ≥ 8 mm was an independent risk factor for incomplete resection.
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Su MY, Chiu CT. Ligation-assisted endoscopic mucosal resection has high complete resection rate in rectal carcinoid tumor. BMC Gastroenterol 2021; 21:464. [PMID: 34903169 PMCID: PMC8667363 DOI: 10.1186/s12876-021-02061-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
AIM We aimed to compare the outcomes of different therapeutic modalities in rectal carcinoid tumors. METHOD We retrospectively collected 145 patients with rectal carcinoid tumors which were pathologically diagnosed from 2005/01/01 to 2016/12/31. We compared tumor size, complete resection rate and recurrent rate between different therapeutic modalities. Then, prospectively compared the treatment outcomes of 28 patients treated with ligation assisted endoscopic mucosal resection (LEMR) and 25 patients treated with endoscopic mucosal resection with cap (EMRC). RESULT The mean size of tumors was 6.5 mm (1-25 mm), and the mean follow-up duration was 26 months (6-118 months). The therapeutic modalities included ligation-assisted endoscopic mucosal resection (LEMR) (25 tumors, 17%), endoscopic mucosal resection (EMR) (31 tumors, 21%), snare polypectomy (30 tumors, 21%), biopsy forceps removal (46 tumors, 32%) and surgical resection (13 tumors, 11%), including 6 tumors treated with transanal endoscopic microsurgery (TEM) method. In view of pathologically complete resection rate, LEMR was highest (100%), followed by surgical resection (85%). However, EMR only had 42% pathologically complete resection rate. Besides, LEMR and surgical resection had no local recurrence and significantly higher clinically complete resection rate, compared to other treatments. For the further prospective study, complete resection was noted in 28 (100%) patients in LEMR group and 13 (52%) patients in EMRC group. CONCLUSION In the treatment of rectal carcinoid tumors, LEMR is safe and effective compared with traditional endoscopic treatments.
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Affiliation(s)
- Ming-Yao Su
- Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, 6, Sec 2, Jincheng Rd, Tucheng Dist, New Taipei City, Taiwan, Republic of China. .,Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan. .,Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Taiwan Association for the Study of Small Intestinal Diseases, Taoyuan, Taiwan.
| | - Cheng-Tang Chiu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan.,Taiwan Association for the Study of Small Intestinal Diseases, Taoyuan, Taiwan
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5
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Matsueda K, Kanesaka T, Kitamura M, Shichijo S, Maekawa A, Yamamoto S, Takeuchi Y, Higashino K, Uedo N, Michida T, Honma K, Miyashiro I, Ishihara R. Favorable long-term outcomes of endoscopic resection for nonampullary duodenal neuroendocrine tumor. J Gastroenterol Hepatol 2021; 36:3329-3336. [PMID: 34142385 DOI: 10.1111/jgh.15586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/30/2021] [Accepted: 06/15/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM The long-term outcomes of endoscopic resection for nonampullary duodenal neuroendocrine tumors are limited. We aimed to clarify it. METHODS Consecutive patients with nonampullary duodenal neuroendocrine tumors endoscopically treated at our institute between January 2005 and June 2020 were included in this retrospective study. En bloc and R0 resection rates and adverse events were evaluated as short-term outcomes of endoscopic resection. The 5-year overall and recurrence-free survival rates of patients after endoscopic resection were calculated as long-term outcomes. RESULTS Of 34 patients with 34 lesions, 33 patients (97%) underwent endoscopic mucosal resection, and one (3%) underwent endoscopic submucosal dissection. En bloc resection was achieved in 33 lesions (97%). R0 resection was achieved in 20 lesions (59%). The median tumor size was 6 mm (range: 3-13). Thirty-one lesions (91%) and three lesions (9%) were classified as G1 and G2, respectively. Lymphovascular invasion was observed in six lesions (18%). Intraprocedural perforation occurred in four patients (12%) who were conservatively treated with endoscopic closure. All 34 patients were followed up without additional treatment after endoscopic resection, and no recurrence or metastasis developed during the median follow-up period of 47.9 months (range: 9.0-187.1). The 5-year overall survival and recurrence-free survival rates were 87.1% and 100%, respectively. CONCLUSIONS Endoscopic resection provided a favorable long-term prognosis for patients with nonampullary duodenal neuroendocrine tumors without lymph node metastasis.
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Affiliation(s)
- Katsunori Matsueda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.,Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masanori Kitamura
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tomoki Michida
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Keiichiro Honma
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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6
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Clinical utility of endoscopic submucosal dissection using the pocket-creation method with a HookKnife and preoperative evaluation by endoscopic ultrasonography for the treatment of rectal neuroendocrine tumors. Surg Endosc 2021; 36:375-384. [DOI: 10.1007/s00464-021-08292-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023]
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7
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Lee HS, Moon HS, Kwon IS, Park JH, Kim JS, Kang SH, Lee ES, Kim SH, Sung JK, Lee BS, Jeong HY. Comparison of conventional and modified endoscopic mucosal resection methods for the treatment of rectal neuroendocrine tumors. Surg Endosc 2020; 35:6055-6065. [PMID: 33094828 DOI: 10.1007/s00464-020-08097-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM Small rectal neuroendocrine tumors (NETs) confined to the submucosa are endoscopically resectable. Because most rectal NETs are submucosal tumors, conventional endoscopic mucosal resection (cEMR) may not result in a complete resection. This study investigated whether modified EMRs, namely endoscopic submucosal resection with ligation (ESMR-L), EMR with precutting (EMR-P), and strip biopsy are superior to cEMR for achieving histologically complete resection (HCR) of rectal NETs. METHODS Medical records of 215 patients who were treated with endoscopic resections for rectal NETs between January 2011 and July 2019 were retrospectively enrolled. Of the patients, 110, 33, 29, and 43 underwent cEMR, ESMR-L, EMR-P, and strip biopsy, respectively. For each method, HCR and en bloc resection rates, procedure times, and complication rates were measured. RESULTS HCR was achieved with cEMR, EMR-P, ESMR-L, and strip biopsies for 74.5%, 90.9%, 93.1%, and 90.7% of cases, respectively. The HCR rate for cEMR was inferior to those of the modified EMRs (p = 0.045 for cEMR vs. EMR-P; p = 0.031 for cEMR vs. ESMR-L; p = 0.027 for cEMR vs. strip biopsy). Among the three modified EMRs, there was no significant difference in achieving HCR (p = 1.000). En bloc resection (p = 0.096) and complication rates (p = 0.071) were not significantly different among the four EMR methods, although EMR-P required the longest procedure time (p = 0.000). CONCLUSIONS All three modified EMRs are superior to cEMR and are equally effective for achieving HCR of rectal NETs.
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Affiliation(s)
- Hee Sung Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hee Seok Moon
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, 35015, South Korea
| | - Jae Ho Park
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Ju Seok Kim
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Sun Hyung Kang
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Eaum Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Seok Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Jae Kyu Sung
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Byung Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hyun Yong Jeong
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
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8
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Relevant risk factors and the prognostic impact of positive resection margins after endoscopic resection of gastrointestinal neuroendocrine tumors. Wideochir Inne Tech Maloinwazyjne 2020; 15:276-282. [PMID: 32489487 PMCID: PMC7233153 DOI: 10.5114/wiitm.2019.89192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/22/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction Endoscopic resection for the treatment of gastrointestinal neuroendocrine tumors has a risk of resection margin residues. The related risk factors and prognosis of post-endoscopic resection margin residues have not been fully evaluated. Aim To investigate the associated risk factors and prognostic impact of resection margin residues after endoscopic resection of gastrointestinal neuroendocrine tumors. Material and methods We conducted a retrospective analysis of 129 patients who underwent endoscopic resection for the treatment of gastrointestinal neuroendocrine tumors. Sex, age, location, diameter of tumor, depth of invasion, endoscopic treatment methods, endoscopic ultrasonography (EUS) evaluation, and the work experience of endoscopists were evaluated as potential risk factors. In addition, the prognoses of patients with positive resection margins were analyzed. Results A total of 18 (18/129, 14.0%) patients exhibited positive resection margins after endoscopic resection. Among 16 successfully followed-up patients, 1 died due to rupture of pulmonary artery aneurysms, 2 underwent supplementary surgical operations, and 2 underwent additional endoscopic submucosal dissection. The remaining 11 patients were periodically followed up, and no recurrences were found. The results of univariate analysis suggested that endoscopic treatment method, the depth of invasion, and EUS evaluation correlated with positive resection margin. Multivariate regression analysis suggested that the depth of invasion and EUS evaluation were risk factors for resection margin residues. Conclusions The depth of invasion and EUS evaluation are independent risk factors for positive resection margins after endoscopic resection. This finding suggests that a greater depth of invasion increases the risk for positive resection margins, while EUS evaluation before resection decreases this risk.
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de Mestier L, Lorenzo D, Fine C, Cros J, Hentic O, Walter T, Panis Y, Couvelard A, Cadiot G, Ruszniewski P. Endoscopic, transanal, laparoscopic, and transabdominal management of rectal neuroendocrine tumors. Best Pract Res Clin Endocrinol Metab 2019; 33:101293. [PMID: 31326374 DOI: 10.1016/j.beem.2019.101293] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rectal neuroendocrine tumors (RNET) are rare tumors but their prevalence is constantly increasing due to a prolonged survival and rising incidence related to a growing number of colonoscopies and improved knowledge. Their main prognostic determinant is tumor stage. While most RNET are localized, their management should be tailored depending on the presence or absence of the factors predictive of lymph-node metastases including tumor size, endoscopic aspect, T stage, grade and lymphovascular invasion. Endoscopic ultrasonography is the most relevant technique for locoregional assessment. Low-risk RNET can be treated using advanced endoscopic resection techniques or transanal endoscopic microsurgery, in expert centers because they require technicity and experience. Conversely, radical surgery with lymphadenectomy should be proposed in the presence of any pejorative factor. The long-term evolution of RNET remains to be specified, and prospective studies should be conducted in order to determine the relevance of the current management strategies.
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Affiliation(s)
- Louis de Mestier
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France; Université de Paris, France; INSERM UMR1149, Paris, France.
| | - Diane Lorenzo
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France; Université de Paris, France
| | - Caroline Fine
- Department of Digestive Oncology, ENETS Centre of Excellence, Edouard Herriot University Hospital, Lyon, France
| | - Jérôme Cros
- Université de Paris, France; INSERM UMR1149, Paris, France; Department of Pathology, ENETS Centre of Excellence, AP-HP, Bichat/Beaujon Hospital, Clichy, France
| | - Olivia Hentic
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France
| | - Thomas Walter
- Department of Digestive Oncology, ENETS Centre of Excellence, Edouard Herriot University Hospital, Lyon, France
| | - Yves Panis
- Université de Paris, France; Department of Colorectal Surgery, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France
| | - Anne Couvelard
- Université de Paris, France; INSERM UMR1149, Paris, France; Department of Pathology, ENETS Centre of Excellence, AP-HP, Bichat/Beaujon Hospital, Clichy, France
| | - Guillaume Cadiot
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert Debré Hospital and Reims-Champagne-Ardennes University, Reims, France
| | - Philippe Ruszniewski
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France; Université de Paris, France; INSERM UMR1149, Paris, France
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10
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Kobori I, Katayama Y, Kitagawa T, Fujimoto Y, Oura R, Toyoda K, Kusano Y, Ban S, Tamano M. Pocket Creation Method of Endoscopic Submucosal Dissection to Ensure Curative Resection of Rectal Neuroendocrine Tumors. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 26:207-211. [PMID: 31192290 DOI: 10.1159/000491559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/21/2018] [Indexed: 12/26/2022]
Abstract
Purpose Pancreatic/gastrointestinal tract neuroendocrine neoplasm (NEN) is divided into neuroendocrine tumor (NET) and neuroendocrine carcinoma (NEC) according to the grade of malignancy, and differences are seen in clinical prognosis. NET, and rectal NET in particular, is often treated endoscopically. Endoscopic mucosal resection (EMR) was previously the main intervention for rectal NET, but EMR with a ligation device (EMR-L) and endoscopic submucosal dissection (ESD) are now also used. However, complete resection with these therapies is not always achieved. The pocket creation method (PCM) is a safe ESD method for colon tumors that offers a high en bloc resection rate compared with conventional colonic ESD. We performed ESD using the PCM for rectal NET and evaluated the complete resection rate. Methods We performed ESD using the PCM in 4 patients. This procedure was technically feasible in all patients. Results Endoscopically, all cases were resected en bloc, and pathological complete resection was achieved in all cases. No complications such as perforation or delayed postoperative bleeding were encountered. Conclusions PCM should be considered when treating NET of appropriate size.
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Affiliation(s)
- Ikuhiro Kobori
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
| | - Yasumi Katayama
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan.,Endoscopy Center, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
| | - Tomoyuki Kitagawa
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
| | - Yo Fujimoto
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
| | - Ryosuke Oura
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
| | - Koji Toyoda
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
| | - Yuumi Kusano
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
| | - Shinichi Ban
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
| | - Masaya Tamano
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
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11
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Choi CW, Park SB, Kang DH, Kim HW, Kim SJ, Nam HS, Ryu DG. The clinical outcomes and risk factors associated with incomplete endoscopic resection of rectal carcinoid tumor. Surg Endosc 2017; 31:5006-5011. [PMID: 28936630 DOI: 10.1007/s00464-017-5497-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/28/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM The risk of lymph node metastasis of a small rectal carcinoid tumor (<10 mm) is known to be lower than that of tumors at other gastrointestinal sites. Although rectal carcinoid tumors can be treated by endoscopic resection, the resected specimen may be incomplete. The consequences of an incomplete resection are not well known. METHOD From December 2008 to November 2015, cases of rectal carcinoid tumors resected by endoscopic resection techniques such as endoscopic submucosal dissection (ESD), or endoscopic mucosal resection using band ligation device (EMR-L), or cap aspiration (EMR-C) were enrolled. The factors associated with incomplete endoscopic resection and clinical outcomes were retrospectively analyzed. RESULTS During the study period, a total of 134 rectal carcinoid tumors were resected by endoscopic techniques; ESD (n = 53), EMR-C (n = 65), and EMR-L (n = 16). The mean tumor size was 5.5 ± 2.4 mm. The mean follow-up period was 835 ± 501 days. The en bloc resection and complete resection rates were 100 and 85.8%, respectively. Procedure time was longer and the size of the resected tumor was larger in the ESD group than in the EMR-C or EMR-L (p < 0.001) group by the univariate analysis. A factor related to incomplete resection was central depression on the surface (OR 11.529, 95% CI 2.377-55.922, p = 0.002), as revealed by the multivariate analysis. Nineteen patients had an incomplete resection status and did not undergo additional resection treatment; none of these patients had recurrence during the study period. CONCLUSIONS A rectal carcinoid tumor with a central depression on the surface was associated with a higher incomplete resection rate. After an incomplete resection of small rectal carcinoid tumors, without evidence of lymphovascular invasion, a periodic follow-up examination without additional resection may be recommended.
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Affiliation(s)
- Cheol Woong Choi
- Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 50612, South Korea
| | - Su Bum Park
- Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 50612, South Korea
| | - Dae Hwan Kang
- Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 50612, South Korea.
| | - Hyung Wook Kim
- Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 50612, South Korea.
| | - Su Jin Kim
- Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 50612, South Korea
| | - Hyeong Seok Nam
- Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 50612, South Korea
| | - Dae Gon Ryu
- Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 50612, South Korea
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Matsuhashi N, Takahashi T, Tomita H, Araki H, Ibuka T, Tanaka K, Tanahashi T, Matsui S, Sasaki Y, Tanaka Y, Okumura N, Yamaguchi K, Osada S, Yoshida K. Evaluation of treatment for rectal neuroendocrine tumors sized under 20 mm in comparison with the WHO 2010 guidelines. Mol Clin Oncol 2017; 7:476-480. [PMID: 28894583 DOI: 10.3892/mco.2017.1326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/04/2017] [Indexed: 12/13/2022] Open
Abstract
Rectal neuroendocrine tumor (NET) is a relatively rare lesion of the gastrointestinal tract, but the prospective examination with colonofiberoscopy or endoscopic ultrasound has increased the frequency of its detection. It is often difficult to determine the optimal treatment for NETs sized <20 mm in the clinical setting. Other clinicopathological variables are not considered in the current guidelines and staging systems. Although the effects of lymphovascular invasion are not covered by the World Health Organization (WHO) 2010 guidelines or tumor-node-metastasis (TNM) staging system, this may be promising for the establishment of improved guidelines and staging systems, particularly for early-stage colorectal carcinoids. The aim of the present study was to evaluate rectal NETs sized <20 mm in comparison with the WHO 2010 guidelines. Between January 2005 and December 2013, 40 consecutive patients [26 men and 14 women; median age, 59.3 years (range, 34-81 years)] who underwent endoscopic resection of rectal NETs, and 12 patients undergoing surgical resection of rectal NETs, were enrolled in this retrospective study. The median tumor size was 7.4 mm (range, 3-15 mm). The locations of the NET were the rectosigmoid colon (n=3), the upper rectum (n=13), and the lower rectum (n=25). The NETs were classified by size as 0-5 (n=7), 6-10 (n=29) and 11-15 mm (n=4). The surgical procedures performed included low anterior resection plus esophagectomy (n=1), laparoscopic low anterior resection (n=7) and laparoscopic intersphincteric resection (n=4). Only 1 patient had lymph node metastasis (tumor sized 6-10 mm, with lymphovascular invasion). NET recurrence was not detected in any of the patients. According to the WHO guidelines, the tumors were classified as grade (G)1 (n=8), G2 (n=3) and G1/G2 (n=1). The tumor in the patient with lymph node metastasis was G1. NETs sized <10 mm may be curatively treated by endoscopic resection. However, NETs with either lymphovascular invasion or sized >1 cm carry a risk for metastasis equivalent to that of adenocarcinomas. Therefore, it is mandatory to histologically examine lymphovascular invasion in specimens retrieved via endoscopic resection to determine the necessity for further radical surgery with regional lymph node dissection. The treatment of NETs sized <20 mm as presently defined in the WHO 2010 guidelines requires further evaluation.
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Affiliation(s)
- Nobuhisa Matsuhashi
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Takao Takahashi
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Hiroyuki Tomita
- Department of Tumor Pathology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Hiroshi Araki
- Department of Gastroenterology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Takashi Ibuka
- Department of Gastroenterology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Kaori Tanaka
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Toshiyuki Tanahashi
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Satoshi Matsui
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Yoshiyuki Sasaki
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Yoshihiro Tanaka
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Naoki Okumura
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Kazuya Yamaguchi
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Shinji Osada
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
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Nakamura K, Osada M, Goto A, Iwasa T, Takahashi S, Takizawa N, Akahoshi K, Ochiai T, Nakamura N, Akiho H, Itaba S, Harada N, Iju M, Tanaka M, Kubo H, Somada S, Ihara E, Oda Y, Ito T, Takayanagi R. Short- and long-term outcomes of endoscopic resection of rectal neuroendocrine tumours: analyses according to the WHO 2010 classification. Scand J Gastroenterol 2016; 51:448-55. [PMID: 26540372 DOI: 10.3109/00365521.2015.1107752] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Although the World Health Organisation (WHO) defined a novel classification of gastroenteropancreatic neuroendocrine tumours (NETs) in 2010, indications for endoscopic resection of rectal NETs in the guidelines were based on evidence accumulated for carcinoid tumours defined by a previous classification. This study was designed to clarify indications for endoscopic resection of rectal NETs corresponding to the new WHO classifications. MATERIAL AND METHODS One hundred-seventy rectal NETs resected endoscopically from April 2001 to March 2012 were histologically re-classified according to the WHO 2010 criteria. The clinicopathological features of these lesions were analysed, and the short- and long-term outcomes of endoscopic resection were evaluated. RESULTS Of the 170 rectal NETs, 166 were histopathologically diagnosed as NET G1 and four as NET G2. Thirty-eight tumours (22.4%) were positive for lymphovascular invasion, a percentage higher than expected. Although the curative resection rate was low (65.3%), en bloc (98.8%) and complete (85.9%) resection rates were high. Modified endoscopic mucosal resection (88.0%) and endoscopic submucosal dissection (92.2%) resulted in significantly higher complete resection rates than conventional endoscopic mucosal resection (36.4%). No patient experienced tumour recurrence, despite the low curative resection rate. CONCLUSION Despite the low curative resection rate, prognosis after endoscopic resection of rectal NETs was excellent. Prospective large-scale, long-term studies are required to determine whether NET G2 and tumours >1 cm should be included in the indication for endoscopic resection and whether tumours with lymphovascular invasion can be followed up without additional surgery.
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Affiliation(s)
- Kazuhiko Nakamura
- a Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Mikako Osada
- b Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Ayako Goto
- a Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Tsutomu Iwasa
- a Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Shunsuke Takahashi
- b Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Nobuyoshi Takizawa
- b Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Kazuya Akahoshi
- c Department of Gastroenterology , Aso Iizuka Hospital , Iizuka , Japan
| | - Toshiaki Ochiai
- d Department of Internal Medicine , Saiseikai Fukuoka General Hospital , Fukuoka , Japan
| | - Norimoto Nakamura
- e Department of Gastroenterology , Harasanshin Hospital , Hakata-Ku , Fukuoka , Japan
| | - Hirotada Akiho
- f Department of Gastroenterology , Kitakyushu Municipal Medical Center , Kokurakita-Ku , Kitakyushu , Japan
| | - Soichi Itaba
- g Department of Gastroenterology , Kyushu Rosai Hospital , Kitakyushu, Fukuoka , Japan
| | - Naohiko Harada
- h Department of Gastroenterology , National Hospital Organization Kyushu Medical Center , Chuo-Ku , Fukuoka , Japan
| | - Moritomo Iju
- i Department of Gastroenterology , Fukuoka City Hospital , Hakata-Ku , Fukuoka , Japan
| | - Munehiro Tanaka
- j Department of Gastroenterology and Hepatology , National Hospital Organization Fukuoka Higashi Medical Center , Koga , Japan
| | - Hiroaki Kubo
- k Department of Internal Medicine , Social Insurance Nakabaru Hospital , Shime-Machi , Kasuya-Gun , Japan
| | - Shinichi Somada
- l Department of Gastroenterology , National Hospital Organization Beppu Medical Center , Beppu , Oita Japan
| | - Eikichi Ihara
- a Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Yoshinao Oda
- b Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Tetsuhide Ito
- a Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Ryoichi Takayanagi
- a Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences , Kyushu University , Higashi-Ku , Fukuoka , Japan
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Endoscopic Resection for Small Rectal Neuroendocrine Tumors: Comparison of Endoscopic Submucosal Resection with Band Ligation and Endoscopic Submucosal Dissection. Gastroenterol Res Pract 2016; 2016:6198927. [PMID: 27525004 PMCID: PMC4976186 DOI: 10.1155/2016/6198927] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 05/09/2016] [Accepted: 05/24/2016] [Indexed: 12/15/2022] Open
Abstract
Background and Aims. There is no consensus so far regarding the optimal endoscopic method for treatment of small rectal neuroendocrine tumor (NET). The aim of this study was to compare treatment efficacy, safety, and procedure time between endoscopic submucosal resection with band ligation (ESMR-L) and endoscopic submucosal dissection (ESD). Methods. We conducted a prospective study of patients who visited Inha University Hospital for endoscopic resection of rectal NET (≦10 mm). Pathological complete resection rate, procedure time, and complications were evaluated. Results. A total of 77 patients were treated by ESMR-L (n = 53) or ESD (n = 24). En bloc resection was achieved in all patients. A significantly higher pathological complete resection rate was observed in the ESMR-L group (53/53, 100%) than in the ESD group (13/24, 54.2%) (P = 0.000). The procedure time of ESD (17.9 ± 9.1 min) was significantly longer compared to that of ESMR-L (5.3 ± 2.8 min) (P = 0.000). Conclusions. Considering the clinical efficacy, technical difficulty, and procedure time, the ESMR-L method should be considered as the first-line therapy for the small rectal NET (≤10 mm). ESD should be left as a second-line treatment for the fibrotic lesion which could not be removed using the ESMR-L method.
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Yang DH, Park Y, Park SH, Kim KJ, Ye BD, Byeon JS, Myung SJ, Yang SK. Cap-assisted EMR for rectal neuroendocrine tumors: comparisons with conventional EMR and endoscopic submucosal dissection (with videos). Gastrointest Endosc 2016; 83:1015-22; quiz 1023-.e6. [PMID: 26460225 DOI: 10.1016/j.gie.2015.09.046] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 09/08/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The incidence of rectal neuroendocrine tumors (NETs) is increasing, and most small rectal NETs can be treated endoscopically. Cap-assisted EMR (EMR-C) was suggested as an effective treatment for rectal NETs in a few studies. We aimed to compare the outcomes of conventional EMR, EMR-C, and endoscopic submucosal dissection (ESD) for the treatment of rectal NETs. METHODS A total of 138 rectal NETs were treated endoscopically by a single endoscopist at Asan Medical Center. We analyzed 122 rectal NETs that had been removed by using EMR (n = 56), EMR-C (n = 34), or ESD (n = 32). RESULTS The histologic complete resection rate was higher in the EMR-C group than in the EMR group (94.1% vs 76.8%, P = .032). Intraprocedural bleeding tended to be more frequent in the EMR-C group than in the EMR group (8.8% vs 0%, P = .051). No differences in the rates of adverse events or histologic complete resections were observed between the EMR-C group and the ESD group for 6-mm to 8-mm NETs; however, the procedure time was significantly shorter in the EMR-C group (3.9 ± 1.1 minutes) than in the ESD group (19.0 ± 12.1 minutes) (P < .001). There was no recurrence in any of the 3 groups. CONCLUSIONS EMR-C is the preferable technique for endoscopic resection of small rectal NETs.
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Affiliation(s)
- Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yangsoon Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyung-Jo Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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16
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Qiao WG, Ren YT, Gong W, Jiang B, Liu SD, Zhou D, Li J, Xing TY, Bai Y, Zhi FC. Cap-aspiration lumpectomy for small submucosal tumors originating from the muscularis propria of the gastric fundus: a preliminary study (with videos). J Dig Dis 2015; 16:642-8. [PMID: 26431118 DOI: 10.1111/1751-2980.12292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 09/21/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Small fundal submucosal tumors (SMTs) originated from the muscularis propria pose great difficulties to conventional therapies. We aimed to evaluate the feasibility and safety of endoscopic cap-aspiration lumpectomy (CASL) as a new and simple full-thickness resection for the treatment of small fundal SMTs. METHODS From July 2013 to February 2014, patients with small fundal SMTs of ≤10 mm in diameter that were originated from muscularis propria were included in the study. CASL was performed by suctioning SMTs into a transparent cap, ligating with a metal snare and resecting the tumors. The wall deficit was closed by using endoclips. RESULTS Altogether 28 patients were included in the study. CASL achieved an en bloc resection rate of 100%, with a mean total procedure time of 23.9 min. Active perforation was found in 20 (71.4%) patients, and endoclips closed the wall defect in all 20 cases. One patient developed pneumoperitoneum and self-limited peritonitis was found in two patients, all of whom were managed successfully. Pathological examination showed that 71.4% (20/28) of the tumors were gastrointestinal stromal tumors. No tumor recurrence was observed during the follow-up. CONCLUSIONS CASL may be a feasible and safe full-thickness resection modality for the treatment of small fundal SMTs arising from the muscularis propria. Further randomized studies are needed to confirm the results.
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Affiliation(s)
- Wei Guang Qiao
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province
| | - Yu Tang Ren
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China
| | - Wei Gong
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province
| | - Bo Jiang
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China
| | - Si De Liu
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province
| | - Dan Zhou
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province
| | - Jing Li
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province
| | - Tong Yin Xing
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province
| | - Yang Bai
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province
| | - Fa Chao Zhi
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province
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17
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Endoscopic submucosal dissection for the treatment of rectal carcinoid tumors 7-16 mm in diameter. Int J Colorectal Dis 2015; 30:375-80. [PMID: 25596026 DOI: 10.1007/s00384-014-2117-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Small rectal carcinoid tumors (<10 mm) are often removed via endoscopic submucosal dissection (ESD). However, the use of ESD for tumors of an intermediate size (7-16 mm) is less well documented. This study aimed to evaluate the efficacy and safety of ESD compared with endoscopic mucosal resection using a cap (EMR-C) for the treatment of 7-16-mm rectal carcinoids. MATERIAL AND METHODS From September 2007 to August 2012, 55 patients with large rectal carcinoid tumors were treated by EMR-C (30 cases) or ESD (25 cases). The en bloc resection rate, pathological complete response (pCR) rate, procedure time, and incidence rates of complications, local recurrence, and distant metastasis were evaluated. RESULTS The basic and clinical characteristics of the patients in the two groups did not differ significantly (p > 0.05). The mean procedure time was longer for ESD than EMR-C (24.79 ± 4.89 vs. 9.52 ± 2.14 min, p < 0.001). The rates of en bloc resection and pCR were higher with ESD than with EMR-C (100 vs. 83.33 %, and 100 vs. 70.00 %, respectively). No patients in the EMR-C group experienced complications. However, in the ESD group, two cases of perforation occurred, and one patient experienced delayed bleeding. These complications were successfully managed via endoscopical therapy. Five cases of local recurrence were detected after EMR-C, whereas no patients experienced recurrence after ESD. CONCLUSIONS Compared with EMR-C, ESD appears to be a more favorable therapeutic option for the treatment of rectal carcinoid tumors less than 16 mm in diameter based on improved rates of pCR and local recurrence.
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The effectiveness of endoscopic submucosal resection with a ligation device for small rectal carcinoid tumors: focused on previously biopsied tumors. Surg Laparosc Endosc Percutan Tech 2015; 24:264-9. [PMID: 24710234 DOI: 10.1097/sle.0b013e3182901176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the effectiveness of endoscopic submucosal resection with a ligation device (ESMR-L) on histologic complete resection for the treatment of small rectal carcinoid tumors in comparison with the treatment with endoscopic mucosal resection (EMR) alone. METHODS Thirty-five patients with small rectal carcinoid tumors were enrolled prospectively for ESMR-L, and we retrospectively reviewed 74 carcinoid tumor patients who underwent EMR. The comparison between ESMR-L and EMR groups was analyzed including endoscopic and histologic complete resection and complications after resection. We also evaluated the associations of histologic complete resection with clinical and procedure-related factors. RESULTS The histologic complete resection rate was significantly higher in ESMR-L than in EMR (94.3% vs. 75.7%, P=0.019). In addition, the resection time was significantly shorter in ESMR-L than in EMR (4.16±1.48 min vs. 5.11±2.47 min, respectively, P=0.014). Moreover, previously biopsied rectal carcinoid tumors were significantly associated with histologic incomplete resection, especially in patients who underwent EMR (odds ratio, 6.28; 95% confidence interval, 1.92-20.58; P=0.002). CONCLUSIONS Compared with EMR, ESMR-L is a safe and effective method for histologic complete resection of small rectal carcinoid tumors, especially in patients with previously biopsied carcinoid tumors.
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Cheung DY, Choi SK, Kim HK, Kim SS, Chae HS, Seo KJ, Cho YS. Circumferential submucosal incision prior to endoscopic mucosal resection provides comparable clinical outcomes to submucosal dissection for well-differentiated neuroendocrine tumors of the rectum. Surg Endosc 2014; 29:1500-5. [DOI: 10.1007/s00464-014-3831-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 08/15/2014] [Indexed: 12/15/2022]
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20
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Komori K, Akahoshi K, Kubokawa M, Motomura Y, Oya M, Ihara E, Nakamura K. Endoscopic submucosal dissection for rectal carcinoid tumour using the Clutch Cutter. ANZ J Surg 2014; 84:847-51. [PMID: 24754306 DOI: 10.1111/ans.12643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND To reduce the risk of complications related to endoscopic submucosal dissection (ESD) using knives, we developed the Clutch Cutter (CC), which can grasp and incise the target tissue similarly to biopsy techniques using an electrosurgical current. The aim of this study was to evaluate the efficacy and safety of ESD using the CC for removal of rectal carcinoid tumours. METHODS Between December 2009 and December 2011, we prospectively enrolled seven patients (seven lesions) on 7 different days. Patients were endoscopically diagnosed with rectal subepithelial lesions (upper rectum, n = 3; lower rectum, n = 4) within the level 3 layer and without lymph node involvement, with the diagnosis confirmed by preliminary endoscopy, endoscopic ultrasound and endoscopic biopsies. ESD using the CC was performed in all cases, and the therapeutic efficacy, safety and tumour recurrence were assessed. RESULTS All lesions were treated easily and safely, and there were no inadvertent incisions. En bloc resection was obtained in all cases, and histologic tumour-free lateral/basal margins were obtained in six of the seven patients. No delayed haemorrhage, perforation or tumour recurrence occurred. CONCLUSION ESD using the CC appears to be an easy, safe and technically efficient method for resecting rectal carcinoid tumour.
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Affiliation(s)
- Keishi Komori
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, Japan
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Choi HH, Kim JS, Cheung DY, Cho YS. Which endoscopic treatment is the best for small rectal carcinoid tumors? World J Gastrointest Endosc 2013; 5:487-494. [PMID: 24147192 PMCID: PMC3797901 DOI: 10.4253/wjge.v5.i10.487] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/07/2013] [Accepted: 08/29/2013] [Indexed: 02/05/2023] Open
Abstract
The incidence of rectal carcinoids is rising because of the widespread use of screening colonoscopy. Rectal carcinoids detected incidentally are usually in earlier stages at diagnosis. Rectal carcinoids estimated endoscopically as < 10 mm in diameter without atypical features and confined to the submucosal layer can be removed endoscopically. Here, we review the efficacy and safety of various endoscopic treatments for small rectal carcinoid tumors, including conventional polypectomy, endoscopic mucosal resection (EMR), cap-assisted EMR (or aspiration lumpectomy), endoscopic submucosal resection with ligating device, endoscopic submucosal dissection, and transanal endoscopic microsurgery. It is necessary to carefully choose an effective and safe primary resection method for complete histological resection.
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Boškoski I, Volkanovska A, Tringali A, Bove V, Familiari P, Perri V, Costamagna G. Endoscopic resection for gastrointestinal neuroendocrine tumors. Expert Rev Gastroenterol Hepatol 2013; 7:559-69. [PMID: 23985005 DOI: 10.1586/17474124.2013.816117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gastrointestinal (GI) and neuroendocrine tumors (NETs) can be treated by mini-invasive endoscopic resection when localized in the superficial layers of the bowel wall and their size is <20 mm. Endoscopic diagnosis of NETs is usually incidental or suspected after clinical, laboratory or imaging findings. Endoscopic mucosal resection is the most commonly used technique for NET removal, endoscopic submucosal dissection is indicated in selected cases, while papillectomy is feasible for ampullary lesions. Histopathologic assessment of the resection margin (circumferential and deep) is important for staging. Incidence of endoscopic mucosal resection-/endoscopic submucosal dissection-related complications for removal of GI NETs are similar to those reported for other GI lesions. Endoscopic follow-up is based on histopathologic characteristics of the resected NETs and its site. NETs >20 mm in size, with penetration of the muscle layer and/or serosa are at high risk for metastases and surgical approach is recommended when feasible.
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Affiliation(s)
- Ivo Boškoski
- Digestive Endoscopy Unit, Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
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Kim KM, Eo SJ, Shim SG, Choi JH, Min BH, Lee JH, Chang DK, Kim YH, Rhee PL, Kim JJ, Rhee JC, Kim JY. Treatment outcomes according to endoscopic treatment modalities for rectal carcinoid tumors. Clin Res Hepatol Gastroenterol 2013; 37:275-82. [PMID: 22959100 DOI: 10.1016/j.clinre.2012.07.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 06/06/2012] [Accepted: 07/03/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite a growing understanding of the clinical effectiveness of endoscopic treatment for small rectal carcinoid tumors, there is still controversy concerning the best endoscopic treatment for resecting rectal carcinoid tumors easily and effectively. OBJECTIVES The objective of the present study was to compare the therapeutic efficacy and safety of endoscopic submucosal resection with a ligation device (ESMR-L) with endoscopic submucosal dissection (ESD) for rectal carcinoid tumors. In addition, a conventional snare-based endoscopic mucosal resection (EMR) was included in the study and compared with both ESMR-L and ESD. METHODS A retrospective analysis was performed in 115 patients who underwent endoscopic resection of a rectal carcinoid tumor between January 2005 and June 2011. These patients were classified into three groups according to the type of endoscopic procedure: EMR group (n=33), ESMR-L group (n=40) and ESD group (n=44). RESULTS The complete resection rate of the EMR group was significantly lower than those of the ESMR-L and ESD groups (77.4 vs. 100 and 97.7%, P=0.002 and P=0.007). Tumor-free vertical margins were significantly greater in the ESMR-L and ESD groups than in the EMR group (ESMR-L and ESD vs. EMR group, P=0.013 and P=0.041). The curative resection rate of rectal carcinoid tumors in the EMR group was 77.4%, which was significantly lower than that of the ESMR-L (95%, 38/40) and EDS groups (97.7%, 43/44) (77.4% vs. 95%, P=0.036 and 77.4% vs. 97.7%, P=0.007). CONCLUSIONS Our results show that ESMR-L and ESD might be superior to conventional EMR for the treatment of small rectal carcinoid tumors.
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Affiliation(s)
- Kwang Min Kim
- Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
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Comparison of endoscopic resection therapies for rectal carcinoid tumor: endoscopic submucosal dissection versus endoscopic mucosal resection using band ligation. J Clin Gastroenterol 2013. [PMID: 23188074 DOI: 10.1097/mcg.0b013e31826faf2b] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopic mucosal resection (EMR) has been the endoscopic treatment of choice for rectal carcinoid tumors <10 mm in size. Endoscopic submucosal dissection (ESD) may cause more severe complications, longer operation time, and higher cost than EMR. AIM : To compare EMR using band ligation (EMR-B) method with ESD for the endoscopic treatment of rectal carcinoid tumors. METHODS From November 2008 to September 2011, we enrolled consecutive patients with rectal carcinoid tumors <10 mm in diameter and without lymph node enlargement. Rate of complete resection rate, incidence of complications, and length of procedures were evaluated. RESULTS Sixty patients were enrolled (31 ESD cases and 29 EMR-B cases). The mean age was 48.03±13.09 years. Both groups had similar mean tumor diameter (EMR-B 4.34±1.75 vs. ESD 5.22±2.09 mm; P=0.084). Resection time was longer in the ESD group than in the EMR-B group (15.09±5.73 vs. 6.37±5.52 min; P<0.001). The complete resection rate was 80.6% (25 of 31) in the ESD group and 82.8% (24 of 29) in the EMR-B group (P=0.833). In incomplete resection cases, neither local recurrence nor distant metastasis was detected during the follow-up period. CONCLUSIONS Compared with ESD, EMR-B resulted in a comparable histologically complete resection rate and took less time to perform. Given the advantages of easier and shorter procedure time, EMR-B may be considered the treatment of choice for small rectal carcinoid tumors.
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Factors associated with complete local excision of small rectal carcinoid tumor. Int J Colorectal Dis 2013; 28:57-61. [PMID: 22821140 DOI: 10.1007/s00384-012-1538-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE Although small rectal carcinoid tumors can be treated using local excision, complete resection can be difficult because tumors are located in the submucosal layer. We evaluate the factors associated with pathologically complete local resection of rectal carcinoid tumors. METHODS Data were analyzed of 161 patients with 166 rectal carcinoid tumors who underwent local excision with curative intent from January 2001 to December 2010. A pathologically complete resection (P-CR) was defined as an en bloc resection with tumor-free lateral and deep margins. The study classified treatments into three categories for analysis: conventional polypectomy (including strip biopsy, snare polypectomy, and hot biopsy), advanced endoscopic techniques (including endoscopic mucosal resection with cap and endoscopic submucosal dissection), and surgical local excision (including transanal excision and transanal endoscopic microsurgery). We evaluated the P-CR rate according to treatment method, tumor size, initial endoscopic impression and the use of endoscopic ultrasound (EUS) or transrectal ultrasound (TRUS). RESULTS The mean tumor size was 5.51 ± 2.43 mm (range 2-18 mm) and all lesions were confined to the submucosal layer. The P-CR rates were 30.9, 72.0, and 81.8 % for conventional polypectomy, advanced endoscopic techniques, and surgical local excision, respectively. Univariate analysis showed that P-CR was associated with treatment method, use of EUS or TRUS, and initial endoscopic impression. Multivariate analysis showed that only treatment method was associated with P-CR. CONCLUSION Pathologically complete resection of small rectal carcinoid tumors was more likely to be achieved when using advanced endoscopic techniques or surgical local excision rather than conventional polypectomy.
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Niimi K, Goto O, Fujishiro M, Kodashima S, Ono S, Mochizuki S, Asada-Hirayama I, Konno-Shimizu M, Mikami-Matsuda R, Minatsuki C, Yamamichi N, Koike K. Endoscopic mucosal resection with a ligation device or endoscopic submucosal dissection for rectal carcinoid tumors: an analysis of 24 consecutive cases. Dig Endosc 2012; 24:443-7. [PMID: 23078437 DOI: 10.1111/j.1443-1661.2012.01303.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS Endoscopic submucosal dissection (ESD) has several advantages over conventional endoscopic mucosal resection, including a higher en bloc resection rate and more accurate pathological estimation. However, ESD is a complex procedure that requires advanced endoscopic skills. The aim of our study is to evaluate the efficacy of endoscopic mucosal resection with a ligation device (EMR-L) compared to ESD for rectal carcinoid tumors. METHODS Between September 2003 and April 2011, 24 rectal carcinoid tumors in 24 patients treated by ESD or EMR-L were retrospectively analyzed. The indications for endoscopic treatment were node-negative rectal carcinoid tumors. We compared the therapeutic outcomes of the ESD group (n = 13) and the EMR-L group (n = 11). RESULTS Both groups had similar mean tumor sizes (ESD: 5.5 ± 2.1 mm; EMR-L: 4.4 ± 2.2 mm). The rates of en bloc and complete resection were, respectively, 100% and 92.3% for ESD, and 100% and 100% for EMR-L. Perforations did not occur in either group. Postoperative bleeding occurred in one EMR-L case, and it was endoscopically managed. However, there were no differences in therapeutic outcomes between the two groups. The mean procedure time was longer in the ESD group (28.8 ± 16.2 min) than in the EMR-L group (17.4 ± 4.4 min), without a significant difference. The mean hospitalization period was significantly shorter in the EMR-L group (1.8 ± 3.1 day) than in the ESD group (6.2 ± 2.1 day), and eight EMR-L cases were treated in an outpatient setting. CONCLUSIONS EMR-L is a simple and effective procedure that compares favorably to ESD for small rectal carcinoid tumors.
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Affiliation(s)
- Keiko Niimi
- Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan.
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Usefulness of endoscopic submucosal dissection for the treatment of rectal carcinoid tumors. Eur J Gastroenterol Hepatol 2012; 24:770-4. [PMID: 22433790 DOI: 10.1097/meg.0b013e3283526f38] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM Various techniques of endoscopy have been developed to treat rectal carcinoids. This retrospective study aimed to evaluate the feasibility and efficacy of endoscopic submucosal dissection for the treatment of rectal carcinoids smaller than 10 mm in diameter. PATIENTS AND METHODS A total of 18 consecutive patients were enrolled with 20 carcinoid tumors that had the following characteristics: the diagnosis of a rectal carcinoid smaller than 10 mm, no endoscopic evidence of muscularis propria invasion, and no evidence of lymph node or distant metastasis (11 men and seven women; median age, 69 years; median tumor size, 4 mm). Tumors were resected by endoscopic submucosal dissection with a needle knife and a hook knife. After marking, a one-third to one-half circumferential mucosal incision was made, and subsequently, the submucosa under the lesion was exfoliated. After the submucosa under the tumor was exfoliated, the residual mucosa was incised and the tumor was removed. Complete resection, complication rates, and operation time were evaluated. RESULTS Complete resection was achieved in all cases (100%) without complications. The mean operation time was 34.2 min, which was acceptable in clinical practice. CONCLUSION Endoscopic submucosal dissection with the strategy described above is feasible and efficacious for selected patients with a rectal carcinoid smaller than 10 mm.
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Lee SH, Park SJ, Kim HH, Ok KS, Kim JH, Jee SR, Seol SY, Kim BM. Endoscopic resection for rectal carcinoid tumors: comparison of polypectomy and endoscopic submucosal resection with band ligation. Clin Endosc 2012; 45:89-94. [PMID: 22741138 PMCID: PMC3363123 DOI: 10.5946/ce.2012.45.1.89] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 12/03/2011] [Accepted: 01/10/2012] [Indexed: 12/17/2022] Open
Abstract
Background/Aims Rectal carcinoid tumors, at diagnosis, are as small as 10 mm or less in about 80% of patients. These tumors are generally removed by endoscopic resection. The aim of this study was to compare treatment efficacy and safety between endoscopic submucosal resection with band ligation (ESMR-L) and conventional polypectomy. Methods Between January 2005 and September 2010, a total of 88 patients, who visited at Busan Paik Hospital and Kosin University Gospel Hospital for endoscopic resection of rectal carcinoid, were reviewed, retrospectively. Results Thirty-three cases were treated by ESMR-L, and 55 cases by conventional polypectomy. There were no significant difference in the size of tumor between ESMR-L group and polypectomy group (6.02±2.36 vs. 6.49±3.24 mm, p=0.474). The rate of positive resection margin was significantly lower in ESMR-L group (2/33, 6.1%) than in polypectomy group (19/55, 34.5%; p=0.002). The rate of positive vertical resection margin, among others, was markedly lower in ESMR-L group (1/33, 3.0%) compared to polypectomy group (19/55, 34.5%; p<0.001). Conclusions ESMR-L, rather than conventional polypectomy, is a useful treatment option for removal of rectal carcinoid tumors less than 10 mm in diameter.
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Affiliation(s)
- Sang Heon Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Endoscopic submucosal dissection (ESD) for gastrointestinal carcinoid tumors. Surg Endosc 2011; 26:759-63. [PMID: 21993939 DOI: 10.1007/s00464-011-1948-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 09/11/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastrointestinal (GI) carcinoid tumors less than 10 mm in diameter and limited to the submucosal layer demonstrate a low frequency of lymph node and distant metastasis; endoscopic submucosal dissection (ESD) has been used to treat these tumors. However, the number of reported sample cases of rectal carcinoid tumors treated with ESD remains insufficient, and the safety and efficacy of ESD for gastric and duodenal carcinoid tumors have not been elucidated to date. METHODS From January 2004 to March 2011, a series of 42 gastrointestinal carcinoid tumors (37 rectal, 2 gastric, and 3 duodenal) in 41 consecutive patients were treated with ESD. Therapeutic efficacy, complications, and follow-up results were retrospectively evaluated. RESULTS Sessile type (type Is) was the most prevalent lesion. Mean procedural time was 41 ± 20 min. The mean sizes of tumors and resected specimens were 5 ± 3 mm and 19 ± 7, respectively. The overall rate of en bloc resection was 100% (42/42). Postoperative bleeding occurred in two rectal cases (5%), which were successfully managed with endoscopic clipping. Perforation occurred in two duodenal cases, which could be conservatively managed with medical treatment after endoscopic clipping, and neither laparoscopy nor emergent surgery was needed. No recurrence was observed during the mean follow-up period of 37 months. CONCLUSIONS ESD was a safe and effective endoscopic treatment for rectal and gastric carcinoid tumors, although other treatment modalities were desirable for duodenal carcinoid tumors.
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Moon SH, Hwang JH, Sohn DK, Park JW, Hong CW, Han KS, Chang HJ, Oh JH. Endoscopic submucosal dissection for rectal neuroendocrine (carcinoid) tumors. J Laparoendosc Adv Surg Tech A 2011; 21:695-9. [PMID: 21657940 DOI: 10.1089/lap.2011.0068] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Rectal neuroendocrine (carcinoid) tumors smaller than 1 cm without lymph node metastasis and confined within the submucosal layer (stage T1aN0) can be treated using endoscopic resection. The present study was aimed to assess the safety and efficacy of endoscopic submucosal dissection (ESD) for T1aN0 carcinoid tumors. PATIENTS AND METHODS A total of 35 consecutive patients with a T1aN0 rectal carcinoid tumor were enrolled between March 2007 and December 2009. The study evaluated the histologically complete resection rate, procedure time, complications, and short-term oncological outcomes. RESULTS The mean patient age was 49.0 years (range, 32-74 years), and there were 25 men and 10 women. The mean procedure time was 35.6 minutes (range, 7-82 minutes). All neoplasms were removed in one piece, and the histologically complete resection rate was 74.3% (26 cases including 5 cases showing no residual tumor). No post-ESD bleeding was observed. Abdominal computed tomography scans showed a perforation in 1 patient only, but that perforation was not associated with any peritonitis symptoms, and the patient was discharged on postprocedure day 3. One patient underwent radical surgery after ESD because of angiolymphatic invasion and positive resection margins, and the final pathology revealed no residual tumor or lymph node metastasis. No patient showed local recurrence or distant metastasis during a median follow-up of 25 months (range, 12-43 months). CONCLUSIONS ESD is feasible and safe for treating T1aN0 rectal carcinoid tumors. Further studies are required to accurately determine long-term oncological outcomes.
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Affiliation(s)
- Sang Hui Moon
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
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Jeon SM, Lee JH, Hong SP, Kim TI, Kim WH, Cheon JH. Feasibility of salvage endoscopic mucosal resection by using a cap for remnant rectal carcinoids after primary EMR. Gastrointest Endosc 2011; 73:1009-14. [PMID: 21316666 DOI: 10.1016/j.gie.2010.12.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 12/20/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Secondary endoscopic treatment for remnant lesions of rectal carcinoid tumors after primary EMR or polypectomy is technically difficult because of fibrosis of residual tissues. EMR by using a cap (EMR-C), a method to resect the submucosal layer by suction by using a transparent cap, may be feasible as a salvage treatment. OBJECTIVE To assess the feasibility of salvage EMR-C. DESIGN Retrospective analysis. SETTING Tertiary academic health care system. PATIENTS Thirty-one patients who were referred for salvage treatment of a failed en bloc excision of rectal carcinoid tumors after primary EMR or polypectomy between January 2007 and December 2009. INTERVENTIONS Salvage EMR-C for remnant carcinoid tumors in the rectum. MAIN OUTCOME MEASUREMENTS Rate of complete resection, complications, length of procedure, and recurrence rate. RESULTS The mean age of the patients was 52.0±11.8 years (range 30-78 years). The mean tumor size was 8.9±3.2 mm (range 5.0-13.0 mm). The mean procedure time was 9.1±3.7 minutes, and clear resection margins were pathologically confirmed in all 31 patients. The most common complication of salvage EMR-C was bleeding (7 patients, 22.6%), which was successfully treated by hemoclipping in all cases. The 1-year follow-up colonoscopy and CT results for all patients were negative for recurrence. LIMITATIONS Retrospective design and limited cases at a single center. CONCLUSIONS EMR-C is a feasible salvage therapeutic option for failed en bloc excision after primary endoscopic treatment of rectal carcinoid tumors.
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Affiliation(s)
- Soung Min Jeon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
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Park HW, Byeon JS, Park YS, Yang DH, Yoon SM, Kim KJ, Ye BD, Myung SJ, Yang SK, Kim JH. Endoscopic submucosal dissection for treatment of rectal carcinoid tumors. Gastrointest Endosc 2010; 72:143-9. [PMID: 20381798 DOI: 10.1016/j.gie.2010.01.040] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Accepted: 01/13/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Conventional EMR has been the endoscopic treatment of choice for rectal carcinoid tumors. However, histologically complete resection often cannot be achieved because the carcinoid tumors are located mainly in the submucosal layer. Endoscopic submucosal dissection (ESD), a new method for large colorectal neoplasm resection, may overcome this problem. OBJECTIVE To compare ESD with EMR for the endoscopic treatment of rectal carcinoid tumors. DESIGN A prospective case series with comparison to retrospective controls. SETTING Tertiary-care center. PATIENTS From January 2007 to January 2009 we prospectively enrolled consecutive patients with rectal carcinoid tumors less than 16 mm in diameter and with no regional lymph node enlargement shown by CT or EUS. For comparison, we retrospectively randomly selected patients who had undergone EMR for treatment of rectal carcinoid tumors between March 2000 and December 2006. INTERVENTION We performed ESD of rectal carcinoid tumors in prospectively enrolled patients. MAIN OUTCOME MEASUREMENTS Rate of en bloc resection, rate of histologically complete resection, incidence of complications, and length of procedures. RESULTS The ESD group contained 31 patients (18 male, 13 female; age range 34-65 years), and the EMR group contained 62 patients (42 male, 20 female; age range 22-77 years). Both groups had similar mean rectal carcinoid tumor diameters (ESD 6.8 +/- 2.4 mm, EMR 7.3 +/- 2.2 mm; P = .106). Resection time was longer in the ESD group than in the EMR group (11.4 +/- 3.7 minutes vs 4.2 +/- 3.2 minutes, P < .001). The en bloc resection rate was 100% (31 of 31) in the ESD group and 95.2% (59 of 62) in the EMR group (P = .213). The histologically complete resection rate was 90.3% (28 of 31) in the ESD group and 71.0% (44 of 62) in the EMR group (P = .035). Suspected perforation occurred in 1 ESD patient (3.2%) and in 1 EMR patient (1.6%), and both patients were successfully managed by conservative measures. Immediate bleeding occurred in 1 ESD patient (3.2%) and in 4 EMR patients (6.5%); all instances of bleeding were controlled endoscopically. LIMITATIONS Retrospective control study and limited experience at a single center. CONCLUSION Compared with EMR, ESD resulted in a higher histologically complete resection rate, had a similar complication rate, and took slightly longer to perform. Given the advantages of complete resection, these findings indicate that ESD may be considered for treatment of rectal carcinoid tumors.
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Affiliation(s)
- Hye-Won Park
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Ishii N, Horiki N, Itoh T, Maruyama M, Matsuda M, Setoyama T, Suzuki S, Uchida S, Uemura M, Iizuka Y, Fukuda K, Suzuki K, Fujita Y. Endoscopic submucosal dissection and preoperative assessment with endoscopic ultrasonography for the treatment of rectal carcinoid tumors. Surg Endosc 2009; 24:1413-9. [PMID: 20033710 DOI: 10.1007/s00464-009-0791-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 11/12/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND Rectal carcinoid tumors 10 mm in diameter or smaller located within the submucosal layer can be cured by local excision including endoscopic treatment. But complete resection of these tumors with endoscopic polypectomy is difficult. This study aimed to evaluate the usefulness of endoscopic submucosal dissection (ESD) and endoscopic ultrasonography (EUS) for the treatment of rectal carcinoid tumors. METHODS In this study, 22 rectal carcinoid tumors in 21 patients were evaluated with EUS and treated using ESD from January 2004 to December 2008. RESULTS The mean size of the resected tumors was 6.1 mm (range, 2.0-10 mm) on histopathologic evaluations. When the sizes of the tumors shown by EUS and histopathologic evaluation were compared, the mean values were not significantly different. All the tumors were located within the submucosal layer, and the accuracy of the preoperative depth determination with EUS was 100% (22/22). The mean duration of the ESD procedure was 37 min (range, 20-71 min). The overall rate of en bloc resection with ESD was 100% (22/22). Although postoperative bleeding occurred in two cases (9%), both cases were successfully managed by endoscopic hemostasis. No perforation or recurrence was observed during the mean follow-up period of 30 months (range, 7-66 months). CONCLUSIONS Endoscopic submucosal dissection and preoperative assessment with EUS are effective for treating rectal carcinoid tumors and enabling en bloc resection.
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Affiliation(s)
- Naoki Ishii
- Department of Gastroenterology, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, Japan.
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Fujishiro M. Endoscopic submucosal dissection for colorectal neoplasms. World J Gastrointest Endosc 2009; 1:32-8. [PMID: 21160648 PMCID: PMC2998845 DOI: 10.4253/wjge.v1.i1.32] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 03/31/2009] [Accepted: 04/07/2009] [Indexed: 02/05/2023] Open
Abstract
Although endoscopic submucosal dissection (ESD) gains acceptance as one of the standard treatments for esophageal and stomach neoplasms in Japan, it is still in the developing stage for colorectal neoplasms. In terms of indications, little likelihood of nodal metastasis and technical resectability are principally considered. Some of intramucosal neoplasms, carcinomas with minute submucosal invasion, and carcinoid tumors, which are technically unresectable by conventional endoscopic treatments, may become good candidates for ESD, considering substantial risks and obtained benefits. ESD as a staging measure to obtain histological information of the invasion depth and lymphovascular infiltration is acceptable because preoperative prediction is difficult in some cases. In terms of techniques, advantages of ESD in comparison with other endoscopic treatments are to be controllable in size and shape, and to be resectable even in large and fibrotic neoplasms. The disadvantages may be longer procedure time, heavier bleeding, and higher possibility of perforation. However, owing to refinement of the techniques, invention of devices, and the learning curve, acceptable technical safety has been achieved. Colorectal ESD is very promising and become one of the standard treatments for colorectal neoplasms in the near future.
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Affiliation(s)
- Mitsuhiro Fujishiro
- Mitsuhiro Fujishiro, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
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Yamaguchi N, Isomoto H, Nishiyama H, Fukuda E, Ishii H, Nakamura T, Ohnita K, Hayashi T, Kohno S, Nakao K, Shikuwa S. Endoscopic submucosal dissection for rectal carcinoid tumors. Surg Endosc 2009; 24:504-8. [PMID: 19585069 DOI: 10.1007/s00464-009-0606-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 05/02/2009] [Accepted: 06/16/2009] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has an advantage over endoscopic mucosa resection (EMR) by enabling removal of gastrointestinal neoplasms en bloc. The ESD procedure is the treatment of choice for rectal carcinoids that have classic histologic architecture with minimal cellular pleomorphism and sparse mitoses, but it has not been applied for such tumors. METHODS The ESD procedure was performed for patients with colorectal tumors that fulfilled the inclusion criteria specifying tumor with a diameter of 10 mm or less, no muscular layer invasion, and no metastases to the lymph nodes or distal organs. The ESD procedure was performed for patients with rectal carcinoids but no node or distal metastasis. RESULTS This study enrolled 20 rectal carcinoid tumors from 20 consecutive patients. The mean tumor size was 7.6 mm (range, 3-16 mm). En bloc removal was achieved for all the tumors, and the complete resection (en bloc with tumor-free lateral/basal margins) rate was 90% (18/20). The two cases in which the margins were not evaluable due to burn effects still are free of recurrence and metastasis at this writing. Perforation was seen in one case, which was managed nonsurgically. CONCLUSIONS Precise histolopathogic assessment of the specimens resected en bloc by ESD may reduce tumor recurrence and metastasis after ESD. As the treatment of choice for small rectal carcinoids, ESD is associated with nominal risks of metastatic disease.
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Affiliation(s)
- Naoyuki Yamaguchi
- Department of Endoscopy, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
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Sohn DK, Han KS, Hong CW, Chang HJ, Jeong SY, Park JG. Selection of cap size in endoscopic submucosal resection with cap aspiration for rectal carcinoid tumors. J Laparoendosc Adv Surg Tech A 2009; 18:815-8. [PMID: 19105668 DOI: 10.1089/lap.2008.0210] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Small rectal carcinoid tumors (<or=1 cm in diameter) can be treated by endoscopic resection, but complete resection may be difficult if tumors are located in the deep submucosal layer. This study was performed to identify the clinicopathologic factors affecting the complete resection of small rectal carcinoid tumors, using the endoscopic submucosal resection with cap aspiration technique (ESMR-C). MATERIALS AND METHODS Forty-one consecutive patients with 42 rectal carcinoid tumors who underwent ESMR-C from October 2003 to November 2006 were assessed. Complete resection was defined as a clean margin that was free of tumor invasion at the lateral and inferior edges. RESULTS The rate of complete tumor removal by ESMR-C was 85.7% and no complications occurred. The tumor size, location, and method of resection did not significantly affect the completeness of resection. Univariate analysis showed that the rate of complete resection was significantly higher when using 19.2-mm, compared with 13.9-mm, caps (96.0 vs. 70.6%; P = 0.032). Multivariate analysis showed that the cap size was an independent factor predicting the completeness of resection. CONCLUSION The use of large-sized caps increases the completeness of the resection of rectal carcinoid tumors when using ESMR-C.
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Affiliation(s)
- Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Bensoussan M, Lamarque D, Dousset B, Terris B, Brezault C, Chaussade S. [What is the place of the endoscopic treatment in the endocrine tumors of the rectum?]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2008; 32:985-988. [PMID: 18771868 DOI: 10.1016/j.gcb.2008.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 05/23/2008] [Accepted: 05/25/2008] [Indexed: 05/26/2023]
Affiliation(s)
- M Bensoussan
- Pôle médicochirurgical d'hépatogastroentérologie, unité de gastroentérologie, hôpital Cochin, université Paris-Descartes, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France.
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Fujishiro M. Perspective on the practical indications of endoscopic submucosal dissection of gastrointestinal neoplasms. World J Gastroenterol 2008; 14:4289-95. [PMID: 18666315 PMCID: PMC2731178 DOI: 10.3748/wjg.14.4289] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is a new endoluminal therapeutic technique involving the use of cutting devices to permit a larger resection of the tissue over the muscularis propria. The major advantages of the technique in comparison with polypectomy and endoscopic mucosal resection are controllable resection size and shape and en bloc resection of a large lesion or a lesion with ulcerative findings. This technique is applied for the endoscopic treatment of epithelial neoplasms in the gastrointestinal tract from the pharynx to the rectum. Furthermore, some carcinoids and submucosal tumors in the gastrointestinal tract are treated by ESD. To determine the indication, two aspects should be considered. The first is a little likelihood of lymph node metastasis and the second is the technical resectability. In this review, practical guidelines of ESD for the gastrointestinal neoplasms are discussed based on the evidence found in the literature.
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Abe T, Kakemura T, Fujinuma S, Maetani I. Successful outcomes of EMR-L with 3D-EUS for rectal carcinoids compared with historical controls. World J Gastroenterol 2008; 14:4054-8. [PMID: 18609690 PMCID: PMC2725345 DOI: 10.3748/wjg.14.4054] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the results of endoscopic mucosal resection with a ligation device (EMR-L) combined with three dimensional endoscopic ultrasonography (3D-EUS) using an ultrasonic probe for rectal carcinoids. In addition, diagnosis of the depth and size of lesions by EUS was evaluated.
METHODS: Between January 2003 and March 2007, 20 patients underwent EMR-L with 3D-EUS using an ultrasonic probe (group A). 3D-EUS was combined with EMR-L at the time of injection of sterile physiological saline into the submucosal layer. For comparison, 14 rectal carcinoids that had been treated by EMR-L without 3D-EUS between April 1998 and December 2002 were evaluated as historical controls (group B). EUS was conducted for all of the patients before treatment to evaluate tumor diameter and depth of invasion. The percentage of complete resection and the vertical resection margin were compared between the two groups.
RESULTS: The depth of invasion upon histopathological examination was in complete agreement with the pre-operative findings by EUS. The tumor diameter determined by EUS approximated that found in the tissue samples. There were no significant differences in the gender, tumor sites or tumor diameters between the two groups. The rate of complete resection for groups A and B was 100% and 71%, respectively (P < 0.05). The vertical resection margin of group A was longer than that of group B.
CONCLUSION: EMR-L is effective as an endoscopic treatment for rectal carcinoids. In combination with 3D-EUS, safe and complete resection is further assured.
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Palazzo L. [Non-glandular rectal tumors: where's the limit for treatment?]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2008; 32:S133-S139. [PMID: 18472239 DOI: 10.1016/j.gcb.2008.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- L Palazzo
- Cabinet médicale, 30, rue d'Astorg, 75008, Paris, France.
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Sold MG, Grobholz R, Post S, Enderle MD, Kaehler GFBA. Submucosal cushioning with water jet before endoscopic mucosal resection : Which fluids are effective? Surg Endosc 2008; 22:443-7. [PMID: 17593436 DOI: 10.1007/s00464-007-9449-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Several new techniques have recently been described that allow the endoscopic mucosal resection even of broad-based flat lesions in the gastrointestinal tract. The technique recently described by us of using a water jet dissector (Helix HydroJet) for a selective deposition of liquid in the submucosal lamina has now been combined with different substances, and their effects have been compared. MATERIAL AND METHODS Gastroscopies were carried out in 8 pigs under intubation anesthesia, and 2 submucosal cushions each were created in the stomach using one out of 4 test substances (gelatin, glucose 50, hydroxyethyl starch [HES] 10%, dextran 40), as well as one cushion of isotonic saline solution placed in each area via the Helix HydroJet). The height of the submucosal cushions was intermittently measured over a period of 40 or 20 min, respectively, by miniprobe endosonography. In 7 of the animals the stomach was subsequently subjected to mucosal resection. The specimens and the gastric wall were histologically assessed to evaluate the localization of the liquid cushion and the effect on adjacent layers of the gastric wall. RESULTS All test substances produced strictly selective liquid cushions in the submucosa. With HES 10% and dextran the maximum height of the cushions initially increased and then decreased during the further course to an average of 90% of the initial height within 40 min. Isotonic saline solution showed the most rapid decrease in height (72% after 20 min). The histological assessment confirmed the selective nature of the liquid deposit in the submucosa. DISCUSSION Plasma expanders produced cushions that initially increased in height but then remained constant for a longer period than cushions produced using glucose 50, gelatin, or isotonic saline solution. The combination of transmucosal jet application for elevation of the mucosa with plasma expanders is therefore an interesting approach to optimize endoscopic mucosal resections.
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Affiliation(s)
- M G Sold
- Department of Surgery, University Hospital Mannheim, Ruprechts-Karls-Universität, Heidelberg, D-69110, Germany
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Atkinson RJ, Hurlstone DP. Techniques for the treatment of submucosal rectal tumors: the role of ESMRL. J Gastroenterol Hepatol 2008; 23:165-6. [PMID: 18289348 DOI: 10.1111/j.1440-1746.2007.04974.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Mashimo Y, Matsuda T, Uraoka T, Saito Y, Sano Y, Fu K, Kozu T, Ono A, Fujii T, Saito D. Endoscopic submucosal resection with a ligation device is an effective and safe treatment for carcinoid tumors in the lower rectum. J Gastroenterol Hepatol 2008; 23:218-21. [PMID: 18289355 DOI: 10.1111/j.1440-1746.2008.05313.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Various methods for complete endoscopic resection of rectal carcinoid tumors have been reported; however, the number of cases investigated in each study has been limited. The aim of the present study was to clarify the clinical usefulness of a novel technique named endoscopic submucosal resection with a ligation device (ESMR-L) in a large number of rectal carcinoid tumors. PATIENTS AND METHODS Between January 1999 and March 2005, a total of 61 patients with 63 rectal carcinoid tumors estimated at 10 mm or less in diameter, without atypical features and resected by ESMR-L were recruited for this analysis. The complete resection rate, complications associated with the procedure, local recurrence, and distant metastases were evaluated. RESULTS Sixty-one patients were 36 males and 25 females with a mean age of 59 +/- 11 years (24-76 years). Tumor size ranged from 2 to 12 mm in diameter, with an average size of 6.4 +/- 2.4 mm. Fifty-nine lesions (93.6%) were located in the lower rectum (Rb), three in the upper rectum (Ra) and one in the recto-sigmoid colon (Rs). In total, 60 out of 63 lesions (95.2%) were histologically determined to be completely resected. The complete resection rate for lesions located in the Rb was 98.3%, which was significantly higher than that for lesions in Ra and Rs (50%). Minor bleeding associated with the procedure occurred in five lesions (7.9%), but all cases were successfully managed with hemoclips. Histopathologically, all tumors were located in the submucosal layer, and all were classified as classical-type carcinoids without lymphovascular invasion. Neither local recurrence nor distant metastasis was detected during a median follow-up period of 24 months. CONCLUSION In a large number of cases, ESMR-L proved to be a useful and safe procedure to resect rectal carcinoid tumors 10 mm or less in diameter, especially for those located in the Rb.
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Affiliation(s)
- Yumi Mashimo
- Division of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.
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Endoscopic ultrasonography and submucosal resection in the diagnosis and treatment of rectal carcinoid tumors. Chin Med J (Engl) 2007. [DOI: 10.1097/00029330-200711010-00017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kaehler GFBA, Sold MG, Fischer K, Post S, Enderle M. Selective fluid cushion in the submucosal layer by water jet: advantage for endoscopic mucosal resection. Eur Surg Res 2007; 39:93-7. [PMID: 17299266 DOI: 10.1159/000099597] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Accepted: 11/24/2006] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIM Numerous new techniques have recently been reported and described for the endoscopic mucosal resection of large superficial lesions of the gastrointestinal tract. We present here for the first time the application of a water jet dissector for mucosa elevation. MATERIALS AND METHODS In an ex vivo study, the effectiveness of a water jet dissector (Helix Hydro-Jet) placed directly on the stomach walls of 8 pigs was examined to create a mucosal elevation. After having determined optimal pressures, angle of application, and application times, 13 submucosal fluid cushions were produced in different areas of the stomach walls of 8 pigs in vivo, and the sizes of the resulting submucosal cushions were measured. RESULTS Using pressures between 30 and 70 bar, it was routinely possible to create submucosal fluid cushions in the stomach wall ex vivo as well as in vivo. Histological examination showed a selective edema in the submucosa without damage to the deeper mucosal layers of the gastric wall. CONCLUSIONS The capacity of a targeted high-pressure water jet to penetrate the mucosa and selectively create a fluid cushion in the submucosa facilitates endoscopic resection of the mucosa. This new method could contribute to ameliorate the endoscopic treatment of mucosal tumors which previously could not be resected endoscopically due to their size, extent, or location.
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Affiliation(s)
- G F B A Kaehler
- Department of Surgery, University Hospital Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany.
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Abstract
PURPOSE OF REVIEW To provide an updated review of the diagnosis, management, and treatment of rectal carcinoid tumors, with special emphasis on minimally invasive surgical techniques to treat localized disease. RECENT FINDINGS Carcinoids are morphologically and biologically heterogeneous neuroendocrine tumors that have malignant potential, and are most commonly found in the gastrointestinal tract. The incidence of all carcinoids appears to be increasing, which may reflect improved diagnostic modalities. The rectum is the third most common location for gastrointestinal carcinoids. Recent data have suggested that rectal carcinoids are over-represented in Black and Asian populations. The survival rate for patients with rectal carcinoids is superior to that of carcinoids found elsewhere in the gastrointestinal tract. Tumor size in rectal carcinoids is predictive of metastasis and can reliably guide management. Review of recent literature demonstrates good evidence that localized rectal carcinoids are amenable to local resection. SUMMARY With widespread colorectal cancer screening, heightened awareness, and improved diagnostic modalities, the incidence of rectal carcinoids should continue to increase. There is evidence that convincingly demonstrates that patients with rectal carcinoids less than 2 cm in diameter, localized to the mucosa or submucosa, may be safely and effectively removed via minimally invasive resection.
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Affiliation(s)
- Andrew Y Wang
- Gastroenterology Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Cantor MJ, Davila RE, Faigel DO. Yield of tissue sampling for subepithelial lesions evaluated by EUS: a comparison between forceps biopsies and endoscopic submucosal resection. Gastrointest Endosc 2006; 64:29-34. [PMID: 16813799 DOI: 10.1016/j.gie.2006.02.027] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Accepted: 02/03/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND In most circumstances, subepithelial tumors lack distinct endoscopic and ultrasonographic features. Consequently, definitive diagnosis usually requires tissue acquisition and pathologic confirmation. Establishing a tissue diagnosis is difficult because the yield of forceps biopsies is low. However, prospective data evaluating tissue sampling techniques for subepithelial lesions are currently lacking. OBJECTIVE Our purpose was to prospectively determine the diagnostic yield of endoscopic submucosal-mucosal resection (ESMR) compared with forceps biopsy for lesions limited to the submucosa (third endosonographic layer) of the GI tract. DESIGN A prospective head-to-head comparison was performed. SETTING The study was performed in a tertiary care hospital. PATIENTS Study patients were 23 adults with subepithelial lesions limited to the submucosa. INTERVENTION All submucosal lesions underwent forceps biopsy followed by endoscopic submucosal resection. Biopsy specimens were obtained with large-capacity "jumbo" forceps. A total of 4 double passes (8 biopsy specimens) were collected from each lesion with use of the bite-on-bite technique. Endoscopic resection was then performed with an electrosurgical snare or cap-fitted endoscopic mucosal resection device. MAIN OUTCOME MEASUREMENT The main outcome measurement was the diagnostic yield of biopsy forceps compared with endoscopic submucosal resection. RESULTS Twenty-three patients with lesions limited to the submucosa were identified by endoscopic ultrasonography. All lesions underwent forceps biopsy followed by ESMR. The diagnostic yield of the jumbo forceps biopsy was 4 of 23 (17%), whereas the diagnostic yield of ESMR was 20 of 23 (87%) (P = .0001, McNemar test). CONCLUSION In the evaluation of subepithelial lesions limited to the submucosa, ESMR has a significantly higher diagnostic yield than jumbo forceps biopsy with use of the bite-on-bite technique.
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Affiliation(s)
- Michael J Cantor
- Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA
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