Department of Gastroenterology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China.
Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China.
Turk J Gastroenterol. 2024 Jun;35(6):440-452. doi: 10.5152/tjg.2024.23477.
BACKGROUND/AIMS: Although endoscopic resection is an effective treatment of rectal neuroendocrine neoplasms (R-NENs) with low malignant potential, there is no consensus on the most recommended endoscopic method. This study aimed to assess the efficacy and acceptability of different endoscopic treatments for R-NENs with low malignant potential.
We searched databases for studies on treatments of R-NENs using endoscopic resection. These studies comprised techniques such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), modified endoscopic mucosal resection (EMRM), modified endoscopic submucosal dissection (ESDM), and transanal endoscopic microsurgery (TEM). The primary outcomes assessed were histological complete resection (HCR).
Overall, 38 retrospective studies (3040 R-NENs) were identified. Endoscopic mucosal resection with a cap (EMRC), endoscopic mucosal resection with ligation (EMRL), ESD, ESDM, and TEM demonstrated higher resectability than did EMR in achieving HCR. Endoscopic mucosal resection, EMRC, EMRL, EMRP, EMRD, and EMRU required shorter operation times than did ESD. Endoscopic mucosal resection, EMRC, ESDM, and TEM incurred lower risks than did ESD.
Regarding R-NENs <20 mm with low malignant potential, ESD could be used as the primary treatment. However, TEM may be more effective if supported by economic conditions and hospital facility. With respect to R-NENs <16 mm with low malignant potential, EMRL could be used as the primary treatment. In regard to R-NENs <10 mm with low malignant potential, EMRL, EMRC, and ESD could be used as the primary treatment. However, EMRL and EMRC might be better when operational difficulties and economic conditions were considered.
背景/目的：尽管内镜下切除是治疗低恶性潜能直肠神经内分泌肿瘤（R-NENs）的有效方法，但对于最推荐的内镜方法尚未达成共识。本研究旨在评估不同内镜治疗方法治疗低恶性潜能 R-NENs 的疗效和可接受性。
我们检索了使用内镜下切除治疗 R-NENs 的研究数据库。这些研究包括内镜黏膜切除术（EMR）、内镜黏膜下剥离术（ESD）、改良内镜黏膜切除术（EMRM）、改良内镜黏膜下剥离术（ESDM）和经肛门内镜微创手术（TEM）等技术。主要评估指标为组织学完全切除（HCR）。
共纳入 38 项回顾性研究（3040 例 R-NENs）。与 EMR 相比，EMRC、EMRL、ESD、ESDM 和 TEM 具有更高的 HCR 切除率。与 ESD 相比，EMR、EMRC、EMRL、EMRP、EMRD 和 EMRU 的手术时间更短。与 ESD 相比，EMR、EMRC、ESDM 和 TEM 的风险更低。
对于低恶性潜能、直径<20mm 的 R-NENs，ESD 可作为首选治疗方法。然而，如果经济条件和医院设施允许，TEM 可能更为有效。对于直径<16mm、低恶性潜能的 R-NENs，EMRL 可作为首选治疗方法。对于直径<10mm、低恶性潜能的 R-NENs，EMRL、EMRC 和 ESD 可作为首选治疗方法。然而，如果考虑到操作难度和经济条件，EMRL 和 EMRC 可能更为合适。
