Jiang Xin-Tong, Hu Yang, Gong Jian, Guo Shi-Bin
Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Visc Med. 2023 Oct;39(5):140-147. doi: 10.1159/000533393. Epub 2023 Sep 5.
The aim of the study was to introduce a new endoscopic technology, clip-and-snare assisted endoscopic submucosal resection (CS-ESMR), for treatment of rectal neuroendocrine tumors (NETs) and then to investigate the therapeutic value of CS-ESMR.
In this retrospective study, 67 patients who underwent endoscopic treatment of rectal NETs from March 2017 to December 2021 were analyzed. According to the endoscopic resection methods (endoscopic mucosal resection [EMR], CS-ESMR, and endoscopic submucosal dissection [ESD]), the cases were divided into CS-ESMR group (27 cases), ESD group (31 cases), and EMR group (9 cases). The pathological R0 resection rate and the incidence of adverse events (bleeding and perforation) were compared among the three groups.
There was a significant difference about the pathological R0 resection between the CS-ESMR group and the EMR group and between the CS-ESMR group and the ESD group (both < 0.05). Compared with ESD group, the procedure time, intraoperative bleeding, and the cost of CS-ESMR group are significantly decreased ( < 0.001, < 0.05, < 0.001, respectively).
CS-ESMR may be a safe and effective treatment for rectal NETs with a diameter of less than 10 mm, without muscularis propria invasion and metastasis.
本研究的目的是引入一种新的内镜技术，即夹子-圈套器辅助内镜黏膜下切除术（CS-ESMR），用于治疗直肠神经内分泌肿瘤（NETs），并探讨CS-ESMR的治疗价值。
在这项回顾性研究中，分析了2017年3月至2021年12月期间接受直肠NETs内镜治疗的67例患者。根据内镜切除方法（内镜黏膜切除术[EMR]、CS-ESMR和内镜黏膜下剥离术[ESD]），将病例分为CS-ESMR组（27例）、ESD组（31例）和EMR组（9例）。比较三组的病理R0切除率和不良事件（出血和穿孔）发生率。
CS-ESMR组与EMR组之间以及CS-ESMR组与ESD组之间在病理R0切除方面存在显著差异（均<0.05）。与ESD组相比，CS-ESMR组的手术时间、术中出血量和费用均显著降低（分别为<0.001、<0.05、<0.001）。
对于直径小于10mm、无固有肌层侵犯和转移的直肠NETs，CS-ESMR可能是一种安全有效的治疗方法。
