Li Dazhou, Xie Jiao, Hong Donggui, Liu Gang, Wang Rong, Jiang Chuanshen, Ye Zhou, Xu Binbin, Wang Wen
Department of Gastroenterology, 900TH Hospital of Joint Logistics Support Force, Fuzhou, China.
Scand J Gastroenterol. 2022 Jun;57(6):734-739. doi: 10.1080/00365521.2022.2033828. Epub 2022 Feb 2.
Rectal neuroendocrine tumors (R-NETs) usually invade the submucosa, and so complete resection is difficult. The treatment of choice for R-NETs ≤10 mm in size is endoscopic resection, but there is still controversy concerning the best endoscopic method. This study evaluated the efficacy and safety of ligation-assisted endoscopic submucosal resection combined with endoscopic ultrasonography (ESMR-LUS) for treatment of R-NETs.
We retrospectively analyzed the data of 101 patients with R-NETs ≤10 mm in size who underwent ESMR-LUS ( = 48) or conventional ligation-assisted endoscopic submucosal resection (ESMR-L; = 53) between May 2019 and September 2021 at the 900th Hospital of Joint Logistics Support Force. Complete resection rate, pathological complete resection rate, procedure time, and adverse events were compared between the two groups of patients.
The endoscopic complete resection rate was slightly higher in the ESMR-LUS group than in the ESMR-L group (100 vs. 96.2%, = .496). The pathological complete resection rate was also slightly higher in the ESMR-LUS group (97.9 vs. 88.7%, = .152), these findings, though statistically non-significant, have practical clinical significance. Margin involvement was less common in ESMR-LUS patients than in ESMR-L patients (1 vs. 6). Involvement of the lateral resection margin was found one patient in the ESMR-LUS group versus two patients in the ESMR-L group, and deep resection margin involvement in no patient in the ESMR-LUS group versus four patients in the ESMR-L group. Mean procedure time was longer in the ESMR-LUS group than in the ESMR-L group (11.08 ± 1.89 min vs. 9.38 ± 2.09 min, = .061). Immediate bleeding occurred in two patients in the ESMR-LUS group vs. seven patients in the ESMR-L group. Two patients in the ESMR-L group also suffered perforation; both patients were successfully treated by endoscopy.
ESMR-LUS appears to be a safe and effective technique for removal of small rectal NETs confined to the submucosal layer without metastasis. Further studies are warranted to compare the efficacy and safety of different methods.
直肠神经内分泌肿瘤（R-NETs）通常侵犯黏膜下层，因此完整切除困难。对于直径≤10 mm的R-NETs，治疗选择是内镜下切除，但关于最佳内镜方法仍存在争议。本研究评估了结扎辅助内镜黏膜下剥离术联合内镜超声（ESMR-LUS）治疗R-NETs的疗效和安全性。
我们回顾性分析了2019年5月至2021年9月期间在联勤保障部队第900医院接受ESMR-LUS（n = 48）或传统结扎辅助内镜黏膜下剥离术（ESMR-L；n = 53）的101例直径≤10 mm的R-NETs患者的数据。比较两组患者的完整切除率、病理完整切除率、手术时间和不良事件。
ESMR-LUS组的内镜完整切除率略高于ESMR-L组（100%对96.2%，P = 0.496）。ESMR-LUS组的病理完整切除率也略高（97.9%对88.7%，P = 0.152），这些结果虽然在统计学上无显著差异，但具有实际临床意义。ESMR-LUS患者的切缘受累比ESMR-L患者少见（1例对6例）。ESMR-LUS组有1例患者出现侧切缘受累，而ESMR-L组有2例；ESMR-LUS组无患者出现深部切缘受累，而ESMR-L组有4例。ESMR-LUS组的平均手术时间比ESMR-L组长（11.08±1.89分钟对9.38±2.09分钟，P = 0.061）。ESMR-LUS组有2例患者发生即时出血，而ESMR-L组有7例。ESMR-L组有2例患者还发生了穿孔；两例患者均通过内镜成功治疗。
ESMR-LUS似乎是一种安全有效的技术，可用于切除局限于黏膜下层且无转移的小直肠神经内分泌肿瘤。有必要进一步研究比较不同方法的疗效和安全性。
