Efficacy of Precut Endoscopic Mucosal Resection for Treatment of Rectal Neuroendocrine Tumors
2
조회
0
다운로드
5
인용
0
참고문헌
키워드
초록
Background/Aims: Endoscopic resection is the first-line treatment for rectal neuroendocrine tumors (NETs) measuring <1 cm and those between 1 and 2 cm in size. However, conventional endoscopic resection cannot achieve complete resection in all cases. We aimed to analyze clinical outcomes of precut endoscopic mucosal resection (EMR-P) used for the management of rectal NET. Methods: EMR-P was used to treat rectal NET in 72 patients at a single tertiary center between 2011 and 2015. Both, circumferential precutting and EMR were performed with the same snare device in all patients. Demographics, procedural details, and histopathological features were reviewed for all cases. Results: Mean size of the tumor measured endoscopically was 6.8±2.8 mm. En bloc and complete resection was achieved in 71 (98.6%) and 67 patients (93.1%), respectively. The mean time required for resection was 9.0±5.6 min. Immediate and delayed bleeding developed in six (8.3%) and 4 patients (5.6%), respectively. Immediate bleeding observed during EMR-P was associated with the risk of delayed bleeding. Conclusions: Both, the en bloc and complete resection rates of EMR-P in the treatment of rectal NETs using the same snare for precutting and EMR were noted to be high. The procedure was short and safe. EMR-P may be a good treatment choice for the management of rectal NETs.
Abstract
Background/Aims: Endoscopic resection is the first-line treatment for rectal neuroendocrine tumors (NETs) measuring <1 cm and those between 1 and 2 cm in size. However, conventional endoscopic resection cannot achieve complete resection in all cases. We aimed to analyze clinical outcomes of precut endoscopic mucosal resection (EMR-P) used for the management of rectal NET. Methods: EMR-P was used to treat rectal NET in 72 patients at a single tertiary center between 2011 and 2015. Both, circumferential precutting and EMR were performed with the same snare device in all patients. Demographics, procedural details, and histopathological features were reviewed for all cases. Results: Mean size of the tumor measured endoscopically was 6.8±2.8 mm. En bloc and complete resection was achieved in 71 (98.6%) and 67 patients (93.1%), respectively. The mean time required for resection was 9.0±5.6 min. Immediate and delayed bleeding developed in six (8.3%) and 4 patients (5.6%), respectively. Immediate bleeding observed during EMR-P was associated with the risk of delayed bleeding. Conclusions: Both, the en bloc and complete resection rates of EMR-P in the treatment of rectal NETs using the same snare for precutting and EMR were noted to be high. The procedure was short and safe. EMR-P may be a good treatment choice for the management of rectal NETs.
참고문헌 (19)
- Hauso O, "Neuroendocrine tumor epidemiology:contrasting Norway and North America", Cancer, 113, pp.2655~2664 (2008)
- 조미연, "Current Trends of the Incidence and Pathological Diagnosis of Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs) in Korea 2000-2009: Multicenter Study", Cancer Research and Treatment, 44(3), pp.157~165 (2012), 대한암학회[DOI]
- 김병창, "Variable Clinical Classifications and Diagnostic Coding Systems of Colorectal Neuroendocrine Tumor", Intestinal research, 11(1), pp.14~22 (2013), 대한장연구학회
- Caplin M, "ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms:colorectal neuroendocrine neoplasms", Neuroendocrinology, 95, pp.88~97 (2012)
- Zhong DD, "Endoscopic mucosal resection vs endoscopic submucosal dissection for rectal carcinoid tumours: a systematic review and meta-analysis", Colorectal Dis, 15, pp.283~291 (2013)
- Park HW, "Endoscopic submucosal dissection for treatment of rectal carcinoid tumors", Gastrointest Endosc, 72, pp.143~149 (2010)
- Lee DS, "The feasibility of endoscopic submucosal dissection for rectal carcinoid tumors: comparison with endoscopic mucosal resection", Endoscopy, 42, pp.647~651 (2010)
- Choi HH, "Which endoscopic treatment is the best for small rectal carcinoid tumors?", World J Gastrointest Endosc, 5, pp.487~494 (2013)
- Mashimo Y, "Endoscopic submucosal resection with a ligation device is an effective and safe treatment for carcinoid tumors in the lower rectum", J Gastroenterol Hepatol, 23, pp.218~221 (2008)
- Kim HH, "Efficacy of endoscopic submucosal resection with a ligation device for removing small rectal carcinoid tumor compared with endoscopic mucosal resection: analysis of 100 cases", Dig Endosc, 24, pp.159~163 (2012)
- Zhao ZF, "A comparative study on endoscopy treatment in rectal carcinoid tumors", Surg Laparosc Endosc Percutan Tech, 22, pp.260~263 (2012)
- Wang X, "Endoscopic submucosal dissection for the treatment of rectal carcinoid tumors 7-16 mm in diameter", Int J Colorectal Dis, 30, pp.375~380 (2015)
- Huang J, "Endoscopic mucosal resection with circumferential incision for treatment of rectal carcinoid tumours", World J Surg Oncol, 12, pp.23~ (2014)
- Cheung DY, "Circumferential submucosal incision prior to endoscopic mucosal resection provides comparable clinical outcomes to submucosal dissection for well-differentiated neuroendocrine tumors of the rectum", Surg Endosc, 29, pp.1500~1505 (2015)
- Okano A, "Predictors of bleeding after endoscopic mucosal resection of gastric tumors", Gastrointest Endosc, 57, pp.687~690 (2003)
- Burgess NG, "Risk factors for intraprocedural and clinically significant delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions", Clin Gastroenterol Hepatol, 12, pp.651~661 (2014)
- Kim HS, "Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study", Am J Gastroenterol, 101, pp.1333~1341 (2006)
- Jung Y, "Do we perform a perfect endoscopic hemostasis prophylactically with argon plasma coagulation in colonic endoscopic mucosal resection?", Dig Dis Sci, 60, pp.3100~3107 (2015)
- Kim GU, "Clinical outcomes of rectal neuroendocrine tumors ≤ 10 mm following endoscopic resection", Endoscopy, 45, pp.1018~1023 (2013)