Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland.
Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
Pol Arch Intern Med. 2021 Mar 30;131(3):241-248. doi: 10.20452/pamw.15823. Epub 2021 Feb 23.
Rectal neuroendocrine neoplasms (rNENs) are potentially metastatic lesions. False endoscopic diagnosis and subsequent treatment may lead to nonradical resection and metastases.
This study aimed to analyze the clinical characteristics of rNENs, investigate whether the lesion origin was suspected by endoscopists during examination and if those lesions were subsequently removed using the appropriate method, and assess the outcomes of patients after curative and noncurative resections.
We analyzed the records of patients hospitalized in our department (2006-2019) with a diagnosis of rNENs. We included 40 patients with rNENs, evaluated their clinical characteristics, and investigated whether the neuroendocrine origin of the lesions was suspected on endoscopy. We compared the outcomes of patients treated with the proper method (endoscopic submucosal dissection / endoscopic mucosal resection [ESD / EMR]) and those treated with polypectomy.
Abnormalities appeared as typical, yellowish subepithelial lesions (n = 24), lesions resembling hyperplastic polyps (n = 12), or tumors with central depression (n = 4). The median size was 5.5 mm and most of them were G1 lesions (n = 36). Only 14 of them were suspected to be of neuroendocrine origin at the first endoscopic examination, and 12 were removed by ESD / EMR. The remaining tumors (n = 26) were removed using polypectomy. Most of the patients were disease‑free at follow‑up, but 2 patients after polypectomy and a single patient after nonradical ESD developed metastases.
In most cases, the origin of the lesion was not suspected on colonoscopy and subsequently the tumor was removed using an inappropriate method. Endoscopists do not follow the guidelines when dealing with patients with rNENs and more emphasis should be placed on education on the management of rNENs.
直肠神经内分泌肿瘤（rNENs）是具有潜在转移性的病变。错误的内镜诊断和随后的治疗可能导致非根治性切除和转移。
本研究旨在分析 rNENs 的临床特征，探讨内镜医生在检查过程中是否怀疑病变起源，并是否随后采用适当的方法切除这些病变，并评估根治性和非根治性切除后患者的结局。
我们分析了 2006 年至 2019 年期间在我科住院的 rNENs 患者的病历。我们纳入了 40 例 rNENs 患者，评估了他们的临床特征，并调查了内镜下是否怀疑病变的神经内分泌起源。我们比较了采用适当方法（内镜黏膜下剥离术/内镜黏膜切除术[ESD/EMR]）和采用息肉切除术治疗的患者的结局。
异常表现为典型的、淡黄色黏膜下病变（n=24）、类似增生性息肉的病变（n=12）或中央凹陷的肿瘤（n=4）。病变的中位大小为 5.5mm，其中大多数为 G1 级病变（n=36）。只有 14 例在首次内镜检查时被怀疑为神经内分泌起源，12 例采用 ESD/EMR 切除。其余肿瘤（n=26）采用息肉切除术切除。大多数患者在随访时无疾病，但 2 例息肉切除术和 1 例非根治性 ESD 后患者发生转移。
在大多数情况下，结肠镜检查未怀疑病变起源，随后采用不适当的方法切除肿瘤。内镜医生在处理 rNENs 患者时未遵循指南，应更加重视 rNENs 管理方面的教育。
