Which endoscopic treatment is the best for small rectal carcinoid tumors?

Figure 1 Treatment of rectal carcinoids. EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection.

Figure 2 Endoscopic mucosal resection. A: An approximately 6 mm rectal carcinoid tumor; B: Injection of submucosal saline solution; C: Endoscopic mucosal resection (EMR) procedure; D: A clear, post-EMR ulcer.

Figure 3 Endoscopic mucosal resection using two-channel colonoscopy. A: An approximately 5 mm rectal carcinoid tumor; B: Injection of submucosal saline solution into the base of the lesion using needle forcep; C: Pulling the lesion with grasping forcep and snare resection; D: A clear, post-endoscopic mucosal resection ulcer.

Figure 4 Endoscopic submucosal resection with ligating device. A: Aspiration of a carcinoid tumor into the ligating device; B: Deployed elastic band; C: Snare resection performed below the band; D: A clear, post-endoscopic submucosal resection with ligating device ulcer.

Figure 5 Endoscopic submucosal dissection. A: An approximately 5 mm rectal carcinoid tumor; B: Mucosal incision and submucosal dissection; C: A clear, post-endoscopic submucosal dissection ulcer; D: Endoscopic closure of the ulcer floor with endoclips.