Liu JN, Chen H, Fang N. Current status of endoscopic resection for small rectal neuroendocrine tumors. World J Gastroenterol 2025; 31(19): 106814 [DOI: 10.3748/wjg.v31.i19.106814]
Corresponding Author of This Article
Nian Fang, PhD, Professor, Department of Gastroenterology, The Third Affiliated Hospital, Jiangxi Medical College, School of Queen Mary, Nanchang University, No. 128 Xiangshan North Road, Nanchang 330009, Jiangxi Province, China. nianfang_ncu@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. May 21, 2025; 31(19): 106814 Published online May 21, 2025. doi: 10.3748/wjg.v31.i19.106814
Current status of endoscopic resection for small rectal neuroendocrine tumors
Jian-Ning Liu, Hui Chen, Nian Fang
Jian-Ning Liu, Nian Fang, Department of Gastroenterology, The Third Affiliated Hospital, Jiangxi Medical College, School of Queen Mary, Nanchang University, Nanchang 330009, Jiangxi Province, China
Hui Chen, Endoscopic Center, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi’an 710032, Shaanxi Province, China
Nian Fang, Department of Gastroenterology, The First Hospital of Nanchang, Nanchang 330009, Jiangxi Province, China
Co-corresponding authors: Hui Chen and Nian Fang.
Author contributions: Liu JN conceptualized the study, conducted the literature review and drafted the manuscript, created the artwork; Chen H and Fang N both supervised and made critical revisions, and all authors have read and approved the final manuscript. Chen H and Fang N equally contributed to the current manuscript as co-corresponding authors by providing instructive guidance and critical revisions.
Supported by Nanchang High-Level Scientific and Technological Innovation Talents ‘Double Hundred Plan’ Project, China, No. 2022-312.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nian Fang, PhD, Professor, Department of Gastroenterology, The Third Affiliated Hospital, Jiangxi Medical College, School of Queen Mary, Nanchang University, No. 128 Xiangshan North Road, Nanchang 330009, Jiangxi Province, China. nianfang_ncu@163.com
Received: March 9, 2025 Revised: March 21, 2025 Accepted: April 27, 2025 Published online: May 21, 2025 Processing time: 74 Days and 18.3 Hours
Abstract
Rectal neuroendocrine tumor (rNET) is an indolent malignancy often detected during colonoscopy screening. The incidence of rNET has increased approximately 10-fold over the past 30 years. Most rNETs detected during screening endoscopy are small, measuring < 10 mm. Current guidelines recommend endoscopic resection for small, well-differentiated rNET using modified endoscopic submucosal resection (mEMR) or endoscopic submucosal dissection. However, the optimal endoscopic treatment method remains uncertain. This paper summarizes the evidence on mEMR with submucosal stretching, mEMR without submucosal stretching, endoscopic submucosal dissection and endoscopic full-thickness resection. Given that rNETs often exhibit submucosal invasion, achieving adequate resection depth is crucial to ensure histological complete resection. mEMR with submucosal stretching appears favorable due to its high rate of histological complete resection, safety and convenience. Risk factors associated with lymph node and distant metastases are also discussed. A treatment algorithm is proposed to facilitate clinical decision-making.
Core Tip: The initial evaluation of small rectal neuroendocrine tumors should thoroughly assess endoscopic features, including size, location, surface pit pattern and atypical changes. Imaging modalities should be used to rule out possible lymph node involvement and distant metastasis. Cold biopsy or polypectomy should be avoided, and modified endoscopic mucosal resection with submucosal stretching should be chosen as a priority. For small incompletely resected tumors without other risk factors, salvage resection can be carefully considered. Long-term follow-up is necessary if patients decline additional treatment. For patients with complete resection and risk factors, extended follow-up should be considered.
