Endoscopic treatment for rectal neuroendocrine tumor: which method is better?
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Recently, research on rectal neuroendocrine tumors (NETs) has increased during the last few decades. Rectal NETs measuring <10 mmwithout atypical features and confined to the submucosal layer have only 1% risk of metastasis, and the long-term survival probabilityof patients without metastasis at the time of diagnosis is approximately 100%. Therefore, the current guidelines suggest endoscopic resectionof rectal NETs of <10 mm is regarded as a safe therapeutic option. However, there are currently no clear recommendations fortechnique selection for endoscopic resection. The choice of treatment modality for rectal NETs should be based on the lesion size, endoscopiccharacteristics, grade of differentiation, depth of vertical involvement, lymphovascular invasion, and risk of metastasis. Moreover,the complete resection rate, complications, and experience at the center should be considered. Modified endoscopic mucosal resectionis the most suitable resection method for rectal NETs of <10 mm, because it is an effective and safe technique that is relativelysimple and less time-consuming compared with endoscopic submucosal dissection. Endoscopic submucosal dissection should be consideredwhen the tumor size is >10 mm, suctioning is not possible due to fibrosis in the lesion, or when the snaring for modified endoscopicmucosal resection does not work well.
Abstract
Recently, research on rectal neuroendocrine tumors (NETs) has increased during the last few decades. Rectal NETs measuring <10 mmwithout atypical features and confined to the submucosal layer have only 1% risk of metastasis, and the long-term survival probabilityof patients without metastasis at the time of diagnosis is approximately 100%. Therefore, the current guidelines suggest endoscopic resectionof rectal NETs of <10 mm is regarded as a safe therapeutic option. However, there are currently no clear recommendations fortechnique selection for endoscopic resection. The choice of treatment modality for rectal NETs should be based on the lesion size, endoscopiccharacteristics, grade of differentiation, depth of vertical involvement, lymphovascular invasion, and risk of metastasis. Moreover,the complete resection rate, complications, and experience at the center should be considered. Modified endoscopic mucosal resectionis the most suitable resection method for rectal NETs of <10 mm, because it is an effective and safe technique that is relativelysimple and less time-consuming compared with endoscopic submucosal dissection. Endoscopic submucosal dissection should be consideredwhen the tumor size is >10 mm, suctioning is not possible due to fibrosis in the lesion, or when the snaring for modified endoscopicmucosal resection does not work well.
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