Huang Jia-Lan, Gan Ri-Yun, Chen Ze-Han, Gao Ruo-Yu, Li De-Feng, Wang Li-Sheng, Yao Jun
Department of Gastroenterology, The Second Clinical Medical College, Jinan University, Shenzhen 518020, Guangdong Province, China.
Department of Gastroenterology, Shenzhen Luohu People's Hospital, Shenzhen 518020, Guangdong Province, China.
World J Gastrointest Surg. 2023 Mar 27;15(3):440-449. doi: 10.4240/wjgs.v15.i3.440.
Endoscopic resection remains an effective method for the treatment of small rectal neuroendocrine tumors (NETs) (≤ 10 mm). Moreover, endoscopic mucosal resection (EMR) with double band ligation (EMR-dB), a simplified modification of EMR with band ligation, is an alternative strategy to remove small rectal NETs.
To evaluate the feasibility and safety of EMR-dB for the treatment of small rectal NETs (≤ 10 mm).
A total of 50 patients with small rectal NETs, without regional lymph node enlargement or distant metastasis confirmed by endoscopic ultrasound, computerized tomography scan, or magnetic resonance imaging, were enrolled in the study from March 2021 to June 2022. These patients were randomly assigned into the EMR-dB ( = 25) group or endoscopic submucosal dissection (ESD) group ( = 25). The characteristics of the patients and tumors, procedure time, devices cost, complete resection rate, complications, and recurrence outcomes were analyzed.
There were 25 patients (13 males, 12 females; age range 28-68 years old) in the EMR-dB group, and the ESD group contained 25 patients (15 males, 10 females; age range 25-70 years old). Both groups had similar lesion sizes (EMR-dB 4.53 ± 1.02 mm, ESD 5.140 ± 1.74 mm; = 0.141) and resected lesion sizes(1.32 ± 0.52 cm 1.58 ± 0.84 cm; = 0.269). Furthermore, the histological complete resection and bloc resection rates were achieved in all patients (100% for each). In addition, there was no significant difference in the complication rate between the two groups. However, the procedure time was significantly shorter and the devices cost was significantly lower in the EMR-dB group. Besides, there was no recurrence in both groups during the follow-up period.
The procedure time of EMR-dB was shorter compared with ESD, and both approaches showed a similar curative effect. Taken together, EMR-dB was a feasible and safe option for the treatment of small rectal NETs.
内镜切除术仍然是治疗小的直肠神经内分泌肿瘤（NETs）（≤10mm）的有效方法。此外，内镜下黏膜切除术（EMR）联合双圈套扎术（EMR-dB），是一种对带结扎EMR的简化改良术式，是切除小的直肠NETs的替代策略。
评估EMR-dB治疗小的直肠NETs（≤10mm）的可行性和安全性。
2021年3月至2022年6月，共纳入50例经内镜超声、计算机断层扫描或磁共振成像证实无区域淋巴结肿大或远处转移的小的直肠NETs患者。这些患者被随机分为EMR-dB组（n = 25）或内镜黏膜下剥离术（ESD）组（n = 25）。分析患者和肿瘤的特征、手术时间、器械成本、完整切除率、并发症及复发情况。
EMR-dB组有25例患者（男13例，女12例；年龄范围28 - 68岁），ESD组有25例患者（男15例，女10例；年龄范围25 - 70岁）。两组病变大小相似（EMR-dB 4.53±1.02mm，ESD 5.140±1.74mm；P = 0.141），切除病变大小相似（1.32±0.52cm vs 1.58±0.84cm；P = 0.269）。此外，所有患者均实现了组织学完全切除和整块切除率（各为100%）。另外，两组并发症发生率无显著差异。然而，EMR-dB组手术时间明显更短，器械成本明显更低。此外，随访期间两组均无复发。
与ESD相比，EMR-dB的手术时间更短，两种方法疗效相似。综上所述，EMR-dB是治疗小的直肠NETs的一种可行且安全的选择。
