Underwater Endoscopic Mucosal Resection of Small Rectal Neuroendocrine Tumors
Background and Study AimsThe resection strategy for rectal neuroendocrine tumors (NET) < 10 mm is not uniform. We compared the utility of underwater endoscopic mucosal resection (UEMR) to endoscopic submucosal resection with a ligation device (ESMR-L) to resect rectal NETs.Patients and Method...
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| Format: | Article |
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Frontiers Media S.A.
2022-04-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.835013/full |
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| author | Masahiro Okada Satoshi Shinozaki Satoshi Shinozaki Eriko Ikeda Eriko Ikeda Yoshikazu Hayashi Takahito Takezawa Hisashi Fukuda Takaaki Morikawa Masafumi Kitamura Munefumi Arita Tatsuma Nomura Hirotsugu Sakamoto Keijiro Sunada Noriyoshi Fukushima Alan Kawarai Lefor Hironori Yamamoto |
| author_facet | Masahiro Okada Satoshi Shinozaki Satoshi Shinozaki Eriko Ikeda Eriko Ikeda Yoshikazu Hayashi Takahito Takezawa Hisashi Fukuda Takaaki Morikawa Masafumi Kitamura Munefumi Arita Tatsuma Nomura Hirotsugu Sakamoto Keijiro Sunada Noriyoshi Fukushima Alan Kawarai Lefor Hironori Yamamoto |
| author_sort | Masahiro Okada |
| collection | DOAJ |
| description | Background and Study AimsThe resection strategy for rectal neuroendocrine tumors (NET) < 10 mm is not uniform. We compared the utility of underwater endoscopic mucosal resection (UEMR) to endoscopic submucosal resection with a ligation device (ESMR-L) to resect rectal NETs.Patients and MethodsPatients with rectal NET < 10 mm treated with UEMR or ESMR-L were included. Their medical records were retrospectively reviewed.ResultsThirty-two patients were divided into a UEMR group (n = 7) and an ESMR-L group (n = 25). Histopathological diagnosis of NET by biopsy was known before resection in 43% (3/7) in the UEMR group and 68% (17/25) in the ESMR-L group, (p = 0.379). UEMR was performed on an outpatient basis for all patients, and 92% of ESMR-L (23/25) were performed as inpatient procedures (p < 0.001). The procedure time was significantly shorter in the UEMR group than in the ESMR-L group [median (IQR), min, 6 (5–8) vs. 12 (9–14), p = 0.002]. En bloc resection and R0 resection rates were 100% in both groups. Pathological evaluations were predominantly NET G1 in both groups (UEMR: 7/7, 100% and ESMR-L: 23/25, 92%). Two patients in the ESMR-L group developed delayed bleeding, controlled by endoscopic hemostasis. Device costs were significantly higher in the ESMR-L group than the UEMR group by approximately US$180 [median (IQR), $90.45 (83.64–108.41) vs. $274.73 (265.86–292.45), P < 0.001].ConclusionUEMR results in similar resection quality with shorter procedure time and lower costs compared to ESMR-L. We recommend UEMR for the resection of rectal NET < 10 mm. |
| first_indexed | 2024-04-13T06:43:41Z |
| format | Article |
| id | doaj.art-39ac7deff9de493982f73fe98c14be0a |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-13T06:43:41Z |
| publishDate | 2022-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj.art-39ac7deff9de493982f73fe98c14be0a2022-12-22T02:57:40ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-04-01910.3389/fmed.2022.835013835013Underwater Endoscopic Mucosal Resection of Small Rectal Neuroendocrine TumorsMasahiro Okada0Satoshi Shinozaki1Satoshi Shinozaki2Eriko Ikeda3Eriko Ikeda4Yoshikazu Hayashi5Takahito Takezawa6Hisashi Fukuda7Takaaki Morikawa8Masafumi Kitamura9Munefumi Arita10Tatsuma Nomura11Hirotsugu Sakamoto12Keijiro Sunada13Noriyoshi Fukushima14Alan Kawarai Lefor15Hironori Yamamoto16Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, JapanDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, JapanShinozaki Medical Clinic, Utsunomiya, JapanDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, JapanDepartment of Diagnostic Pathology, Jichi Medical University, Shimotsuke, JapanDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, JapanDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, JapanDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, JapanDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, JapanDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, JapanDepartment of Surgery, Jichi Medical University, Shimotsuke, JapanDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, JapanDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, JapanDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, JapanDepartment of Diagnostic Pathology, Jichi Medical University, Shimotsuke, JapanDepartment of Surgery, Jichi Medical University, Shimotsuke, JapanDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, JapanBackground and Study AimsThe resection strategy for rectal neuroendocrine tumors (NET) < 10 mm is not uniform. We compared the utility of underwater endoscopic mucosal resection (UEMR) to endoscopic submucosal resection with a ligation device (ESMR-L) to resect rectal NETs.Patients and MethodsPatients with rectal NET < 10 mm treated with UEMR or ESMR-L were included. Their medical records were retrospectively reviewed.ResultsThirty-two patients were divided into a UEMR group (n = 7) and an ESMR-L group (n = 25). Histopathological diagnosis of NET by biopsy was known before resection in 43% (3/7) in the UEMR group and 68% (17/25) in the ESMR-L group, (p = 0.379). UEMR was performed on an outpatient basis for all patients, and 92% of ESMR-L (23/25) were performed as inpatient procedures (p < 0.001). The procedure time was significantly shorter in the UEMR group than in the ESMR-L group [median (IQR), min, 6 (5–8) vs. 12 (9–14), p = 0.002]. En bloc resection and R0 resection rates were 100% in both groups. Pathological evaluations were predominantly NET G1 in both groups (UEMR: 7/7, 100% and ESMR-L: 23/25, 92%). Two patients in the ESMR-L group developed delayed bleeding, controlled by endoscopic hemostasis. Device costs were significantly higher in the ESMR-L group than the UEMR group by approximately US$180 [median (IQR), $90.45 (83.64–108.41) vs. $274.73 (265.86–292.45), P < 0.001].ConclusionUEMR results in similar resection quality with shorter procedure time and lower costs compared to ESMR-L. We recommend UEMR for the resection of rectal NET < 10 mm.https://www.frontiersin.org/articles/10.3389/fmed.2022.835013/fullendoscopic submucosal resectionneuroendocrine tumorrectal neoplasmspatient outcome assessment (MeSH)underwater endoscopic mucosal resection |
| spellingShingle | Masahiro Okada Satoshi Shinozaki Satoshi Shinozaki Eriko Ikeda Eriko Ikeda Yoshikazu Hayashi Takahito Takezawa Hisashi Fukuda Takaaki Morikawa Masafumi Kitamura Munefumi Arita Tatsuma Nomura Hirotsugu Sakamoto Keijiro Sunada Noriyoshi Fukushima Alan Kawarai Lefor Hironori Yamamoto Underwater Endoscopic Mucosal Resection of Small Rectal Neuroendocrine Tumors Frontiers in Medicine endoscopic submucosal resection neuroendocrine tumor rectal neoplasms patient outcome assessment (MeSH) underwater endoscopic mucosal resection |
| title | Underwater Endoscopic Mucosal Resection of Small Rectal Neuroendocrine Tumors |
| title_full | Underwater Endoscopic Mucosal Resection of Small Rectal Neuroendocrine Tumors |
| title_fullStr | Underwater Endoscopic Mucosal Resection of Small Rectal Neuroendocrine Tumors |
| title_full_unstemmed | Underwater Endoscopic Mucosal Resection of Small Rectal Neuroendocrine Tumors |
| title_short | Underwater Endoscopic Mucosal Resection of Small Rectal Neuroendocrine Tumors |
| title_sort | underwater endoscopic mucosal resection of small rectal neuroendocrine tumors |
| topic | endoscopic submucosal resection neuroendocrine tumor rectal neoplasms patient outcome assessment (MeSH) underwater endoscopic mucosal resection |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.835013/full |
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