Yang Guang, Wang Jingsong, Li Bo, Xian Xiaolong, Ren Jianzhen, Qiu Qiuping, Hong Xiaoping, Huang Longbin, Liao Suhuan, Huang Silin
South China Hospital Affiliated to Shenzhen University, Shenzhen, China.
Endosc Int Open. 2025 Aug 6;13:a26415725. doi: 10.1055/a-2641-5725. eCollection 2025.
Rectal neuroendocrine tumors (r-NETs) exhibit significant heterogeneity and malignant potential. Currently, endoscopic resection is the preferred treatment for r-NETs < 10 mm. However, traditional endoscopic resection carries a risk of positive vertical margins. This study aimed to compare clinical efficacy of endoscopic intermuscular dissection (EID) and endoscopic submucosal dissection (ESD) in treating small r-NETs (< 10 mm).
This retrospective study included 56 patients with r-NETs < 10 mm who underwent endoscopic treatment between April 2017 and September 2024 at Shenzhen University Affiliated South China Hospital and Shenzhen Hospital of Southern Medical University. All procedures were performed by the same surgeon. Patients were divided into two groups based on type of endoscopic treatment: the EID group (n = 16) and the ESD group (n = 40). We compared operative time, technical success rates, resection outcomes, adverse event (AE) rates, and histopathological findings between the two groups.
Median lesion size in the EID group (7.5 mm) was significantly larger than in the ESD group (6.0 mm) ( = 0.001). Although operative time in the EID group was longer (39 vs 28.5 minutes), the difference was not statistically significant ( = 0.137). The complete resection rate was 100% in the EID group and 97.5% in the ESD group, with no statistically significant difference. There were no significant differences in general characteristics, technical success rates (100% vs 100%), or incidence of AEs (bleeding, perforation, infection) (0% vs 0%) between groups ( > 0.05).
Endoscopic intermuscular dissection offers a better option for preventing positive basal margins and demonstrates good safety and feasibility.
直肠神经内分泌肿瘤（r-NETs）具有显著的异质性和恶性潜能。目前，内镜下切除是直径<10 mm的r-NETs的首选治疗方法。然而，传统内镜下切除存在垂直切缘阳性的风险。本研究旨在比较内镜肌间剥离术（EID）和内镜黏膜下剥离术（ESD）治疗小r-NETs（<10 mm）的临床疗效。
本回顾性研究纳入了2017年4月至2024年9月期间在深圳大学附属华南医院和南方医科大学深圳医院接受内镜治疗的56例直径<10 mm的r-NETs患者。所有手术均由同一位外科医生进行。根据内镜治疗方式将患者分为两组：EID组（n = 16）和ESD组（n = 40）。我们比较了两组的手术时间、技术成功率、切除结果、不良事件（AE）发生率和组织病理学结果。
EID组病变的中位大小（7.5 mm）显著大于ESD组（6.0 mm）（P = 0.001）。虽然EID组的手术时间较长（39分钟对28.5分钟），但差异无统计学意义（P = 0.137）。EID组的完整切除率为100%，ESD组为97.5%，差异无统计学意义。两组在一般特征、技术成功率（100%对100%）或不良事件（出血、穿孔、感染）发生率（0%对0%）方面无显著差异（P>0.05）。
内镜肌间剥离术为预防基底切缘阳性提供了更好的选择，且具有良好的安全性和可行性。
