Published online Oct 16, 2013. doi: 10.4253/wjge.v5.i10.487
Revised: August 7, 2013
Accepted: August 28, 2013
Published online: October 16, 2013
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.
Core tip: Rectal carcinoids less than 10 mm in diameter can be resected by various endoscopic techniques, such as conventional polypectomy, endoscopic mucosal resection (EMR), cap-assisted EMR (EMR-C), endoscopic submucosal dissection (ESD), or transanal endoscopic microsurgery (TEM). There are currently limited comparative data to recommend a specific endoscopic treatment. Therefore, the choice of treatment modalities for small rectal carcinoids depends on the degree of endoscopic or surgical expertise at a given facility. Furthermore, any one of the above treatment methods could have a favorable clinical outcome if performed by gastroenterologists or surgeons with special techniques. EMR-C and TEM can be used as a salvage treatment after incomplete resection by endoscopic polypectomy. The efficacy of endoscopic submucosal resection with ligating device and ESD for salvage treatment requires further investigation.