Review
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World J Gastrointest Endosc. Oct 16, 2013; 5(10): 487-494
Published online Oct 16, 2013. doi: 10.4253/wjge.v5.i10.487
Which endoscopic treatment is the best for small rectal carcinoid tumors?
Hyun Ho Choi, Jin Su Kim, Dae Young Cheung, Young-Seok Cho
Hyun Ho Choi, Young-Seok Cho, Division of Gastroenterology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Uijeongbu 480-717, South Korea
Jin Su Kim, Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul 137-701, South Korea
Dae Young Cheung, Division of Gastroenterology, Department of Internal Medicine, Yeoido St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul 150-713, South Korea
Author contributions: Choi HH, Kim JS and Cheung DY collected the materials and wrote the manuscript; Cho YS wrote the manuscript and supervised the work.
Supported by Grant funded by the Catholic Cancer Center made in the program of 2010; and the National Research Foundation of Korea grant funded by the Korea government, No. 2010-0023295
Correspondence to: Young-Seok Cho, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea College of Medicine, 271 Cheonbo-ro, Uijeongbu 480-717, South Korea. yscho@catholic.ac.kr
Telephone: +82-31-8203658 Fax: +82-31-8472719
Received: June 28, 2013
Revised: August 7, 2013
Accepted: August 28, 2013
Published online: October 16, 2013
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.

Keywords: Carcinoid tumor, Rectum, Polypectomy, Endoscopic mucosal resection, Endoscopic submucosal dissection

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.