Traction-assisted endoscopic submucosal resection (TA-ESD) for rectal neuroendocrine tumors: a randomized multi-center trial.

BACKGROUND AND AIM

Endoscopic resection is the first-line choice for the treatment of rectal neuroendocrine tumors (NETs). This study aimed to compare the efficacy and safety of a modified traction-assisted endoscopic submucosal resection (TA-ESD) and traditional endoscopic submucosal resection (ESD).

METHODS

In this multi-center prospective randomized controlled trial, patients with small rectal NET(< 2 cm) were 1:1 randomized into TA-ESD or traditional ESD groups. The operation time was selected as the primary endpoint, while en bloc resection rate, R0 resection rate, complications, length of hospitalization were chosen as secondary endpoints.

RESULTS

A total of 44 patients (22 TA-ESD and 22 ESD patients) were enrolled in this study, of which 40 patients (19 TA-ESD and 21 ESD patients) were pathologically confirmed rectal NET patients. The median operation time was shorter in the TA-ESD group than in the ESD group (7.3 (5.4-9.6) vs. 12.2 (7.8-21.0) minutes, Difference (95% CI) -4.5 (-10.0, -1.3), P = 0.0054). Furthermore, the rates of en bloc resection and R0 resection were 22 (100%) and 22 (100%) in TA-ESD group and ESD group, respectively. Perforation occurred in one patient in the ESD group during the operation and no postoperative complication was recorded in both groups.

CONCLUSION

Compared with traditional ESD, modified TA-ESD is more suitable for the treatment of small rectal NETs than traditional ESD due to its shorter operation time and improved R0 resection rate.