Published online Mar 14, 2019. doi: 10.3748/wjg.v25.i10.1259
Peer-review started: January 14, 2019
First decision: January 23, 2019
Revised: January 29, 2019
Accepted: January 30, 2019
Article in press: January 30, 2019
Published online: March 14, 2019
Rectal carcinoid tumor is a clinically common submucosal tumor of the digestive tract. Lymph node metastasis risk of rectal carcinoid tumors less than 1 cm is low. Endoscopic local resection is currently the main treatment method, of which endoscopic submucosal dissection (ESD) is the first choice. Endoscopic mucosal resection (EMR) is also a commonly used treatment method for digestive tract mucosal lesions, with low technical requirements and relatively easy to grasp. Previous studies have shown that EMR also has a good effect on rectal carcinoids, but there is a residual risk of basal tumors, even with improved EMR (such as EMR-cap, EMR-P, C-EMR and so on). Therefore, it is of certain clinical value to explore a simple and effective method to treat small rectal carcinoids on the basis of EMR.
This study aimed to explore a simple and effective endoscopic resection method for the treatment of small rectal carcinoids, especially when ESD is not available.
The clinical application of ligation assisted endoscopic resection is extensive, especially for gastrointestinal submucosal tumors, and even the tumors less than 2 cm derived from the muscularis propria also can achieve satisfactory results. For some submucosal tumors that may have residual tumor in the basal part after endoscopic resection, the ligation method after endoscopic resection can lead to the final ischemic necrosis of the residual tumor and achieve the purpose of complete resection. The purpose of this study was to explore the efficacy of transparent cap assisted endoscopic mucosal resection combined with postoperative endoloop ligation in the treatment of rectal carcinoids.
This study retrospectively analyzed the cases diagnosed as rectal carcinoid tumors and treated by ligation after cap (LC)-EMR or ESD in the gastroenterology unit of Shenzhen People’s Hospital between January 2016 and Decemeber 2017. Patients' demographic data, the complete resection rates, operation duration, and postoperative complications were collected.
A total of 34 patients including 24 males and 10 females with an average of 19-79 (47.47 ± 12.25) years participated in the study. The mean ages, tumor size, resection time, and pathologically complete resection (P-CR) rates of the ESD (n = 12) and LC-EMR (n = 22) groups were 48.18 ± 12.31 years vs 46.17 ± 12.57 years, 7.23 ± 1.63 mm vs 7.50 ± 1.38 mm, 15.67 ± 2.15 min vs 5.91 ± 0.87 min, and 91.67% (11/12) vs 86.36% (19/22), respectively. No perforation or delayed bleeding was observed in either group. Pathology diagnosis was confirmed as G1. Two of the three cases with a positive margin in the LC-EMR group received transanal rectal tumor resection and tumor cells were not identified in the postoperative specimens. The other case with a positive margin chose follow-up without further operation. One case with remnant tumor after ESD received further local ligation treatment. Neither local recurrence nor lymph node metastasis was found during the follow-up period. Both LC-EMR and ESD were effective methods to treat small rectal carcinoid tumors.
LC-EMR appears to be an efficient and simple method for the treatment for small rectal carcinoid tumors less than 10 mm, especially when ESD is not available. LC-EMR can effectively prevent remnant tumors at the resection margin. Considering rectal carcinoid is a slow-growing tumor, long-term follow-up is necessary to determine the long- term efficacy of LC-EMR.
To avoid local tumor residue after endoscopic resection, it is necessary to perform postoperative prophylactic endoloop ligation, even after ESD.