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Hong SW, Yang DH, Lee YJ, Baek DH, Chun J, Kim HG, Kim SJ, Hong SM, Myung DS. Endoscopic mucosal resection using anchored snare Tip-in versus precut technique for small rectal neuroendocrine tumors. Korean J Intern Med 2024; 39:238-247. [PMID: 38062724 PMCID: PMC10918371 DOI: 10.3904/kjim.2023.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/16/2023] [Accepted: 09/01/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND/AIMS Small rectal neuroendocrine tumors (NETs) can be treated with modified endoscopic mucosal resection (EMR). However, an optimal EMR method remains to be established. We aimed to assess the non-inferiority of Tip-in EMR versus precut EMR (EMR-P) for treating rectal NETs. METHODS This prospective, multicenter, randomized controlled trial enrolled patients with rectal NETs of < 10 mm in diameter. The patients were randomly assigned to EMR-P and Tip-in EMR groups in a 1:1 ratio. Primary outcome was margin-negative (R0) resection rate between the two methods, with a noninferiority margin of 10%. RESULTS Seventy-five NETs in 73 patients, including 64 eligible lesions (32 lesions in each, EMR-P and Tip-in EMR groups), were evaluated. In a modified intention-to-treat analysis, R0 resection rates of the EMR-P and Tip-in EMR groups were 96.9% and 90.6%, respectively, which did not demonstrate non-inferiority (risk difference, -6.3 [95% confidence interval: -18.0 to 5.5]). Resection time in the EMR-P group was longer than that in the Tip-in EMR group (p < 0.001). One case of intraprocedural bleeding was reported in each group. CONCLUSION We did not demonstrate the non-inferiority of Tip-in EMR compared to EMR-P for treating small rectal NETs. However, the R0 resection rates for both techniques were high enough for clinical application.
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Affiliation(s)
- Seung Wook Hong
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Seoul,
Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Seoul,
Korea
| | - Yoo Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu,
Korea
| | - Dong Hoon Baek
- Division of Gastroenterology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan,
Korea
| | - Jaeyoung Chun
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Hyun Gun Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul,
Korea
| | - Sung Joo Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Dae-Seong Myung
- Department of Internal Medicine, Chonnam National Medical School, Gwangju,
Korea
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Rectal neuroendocrine neoplasms: what the radiologists should know. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:4016-4031. [PMID: 35288791 DOI: 10.1007/s00261-022-03474-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 02/06/2023]
Abstract
Neuroendocrine neoplasms of the rectum (R-NENs) are rare; however, their incidence has increased almost threefold in the last few decades. Imaging of R-NENs includes two primary categories: anatomic/morphologic imaging comprised of endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI), and functional/molecular imaging comprising of planar scintigraphy, single-photon emission computed tomography (SPECT), and positron emission tomography (PET). The management depends on stage, dimension, atypical features, histological grade, and lymphovascular invasion (LVI). Low-risk local R-NENs can be resected endoscopically, and high-risk or locally advanced neoplasms can be treated with radical surgery and lymphadenectomy and/or chemoradiation. The review article focuses on imaging illustrations and discusses applications of different imaging modalities in diagnosing and managing R-NENs.
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3
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Kamigaichi Y, Yamashita K, Oka S, Tamari H, Shimohara Y, Nishimura T, Inagaki K, Okamoto Y, Tanaka H, Yuge R, Urabe Y, Arihiro K, Tanaka S. Clinical outcomes of endoscopic resection for rectal neuroendocrine tumors: Advantages of endoscopic submucosal resection with a ligation device compared to conventional EMR and ESD. DEN OPEN 2022; 2:e35. [PMID: 35310732 PMCID: PMC8828204 DOI: 10.1002/deo2.35] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/28/2021] [Accepted: 06/10/2021] [Indexed: 12/19/2022]
Abstract
Objectives Methods Results Conclusions
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Affiliation(s)
- Yuki Kamigaichi
- Department of Endoscopy Hiroshima University Hospital Hiroshima Japan
| | - Ken Yamashita
- Department of Endoscopy Hiroshima University Hospital Hiroshima Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism Hiroshima University Hospital Hiroshima Japan
| | - Hirosato Tamari
- Department of Gastroenterology and Metabolism Hiroshima University Hospital Hiroshima Japan
| | - Yasutsugu Shimohara
- Department of Gastroenterology and Metabolism Hiroshima University Hospital Hiroshima Japan
| | - Tomoyuki Nishimura
- Department of Gastroenterology and Metabolism Hiroshima University Hospital Hiroshima Japan
| | - Katsuaki Inagaki
- Department of Gastroenterology and Metabolism Hiroshima University Hospital Hiroshima Japan
| | - Yuki Okamoto
- Department of Gastroenterology and Metabolism Hiroshima University Hospital Hiroshima Japan
| | - Hidenori Tanaka
- Department of Endoscopy Hiroshima University Hospital Hiroshima Japan
| | - Ryo Yuge
- Department of Endoscopy Hiroshima University Hospital Hiroshima Japan
| | - Yuji Urabe
- Division of Regeneration and Medicine Center for Translational and Clinical Research Hiroshima University Hospital Hiroshima Japan
| | - Koji Arihiro
- Department of Anatomical Pathology Hiroshima University Hospital Hiroshima Japan
| | - Shinji Tanaka
- Department of Endoscopy Hiroshima University Hospital Hiroshima Japan
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Gallo C, Rossi RE, Cavalcoli F, Barbaro F, Boškoski I, Invernizzi P, Massironi S. Rectal neuroendocrine tumors: Current advances in management, treatment, and surveillance. World J Gastroenterol 2022; 28:1123-1138. [PMID: 35431507 PMCID: PMC8985485 DOI: 10.3748/wjg.v28.i11.1123] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/24/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
Rectal neuroendocrine neoplasms (r-NENs) are considered among the most frequent digestive NENs, together with small bowel NENs. Their incidence has increased over the past few years, and this is probably due to the widespread use of endoscopic screening for colorectal cancer and the advanced endoscopic procedures available nowadays. According to the current European Neuroendocrine Tumor Society (ENETS) guidelines, well-differentiated r-NENs smaller than 10 mm should be endoscopically removed in view of their low risk of local and distant invasion. R-NENs larger than 20 mm are candidates for surgical resection because of their high risk of distant spreading and the involvement of the muscularis propria. There is an area of uncertainty regarding tumors between 10 and 20 mm, in which the metastatic risk is intermediate and the endoscopic treatment can be challenging. Once removed, the indications for surveillance are scarce and poorly codified by international guidelines, therefore in this paper, a possible algorithm is proposed.
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Affiliation(s)
- Camilla Gallo
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Roberta Elisa Rossi
- Division of HPB Surgery, Hepatology and Liver Transplantation, Department of Pathophysiology and Transplantation, University of Milan, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), Milan 20133, Italy
| | - Federica Cavalcoli
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan 20133, Italy
| | - Federico Barbaro
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome 00168, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome 00168, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
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5
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An evaluation of resectability among endoscopic treatment methods for rectal neuroendocrine tumors <10 mm. Arab J Gastroenterol 2021; 22:104-110. [PMID: 34053887 DOI: 10.1016/j.ajg.2021.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/23/2021] [Accepted: 05/10/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND STUDY AIMS With respect to rectal neuroendocrine tumor (NET) resection, it remains unclear which of the following methods is the most effective: conventional endoscopic mucosal resection (cEMR), EMR using a fitted cap (EMR-C), EMR with a ligation band device (EMR-L), or endoscopic submucosal dissection (ESD). Thus, in this study, we aim to retrospectively evaluate the most effective endoscopic resection for rectal NETs < 10 mm. PATIENTS AND METHODS In total, 61 consecutive patients with primary rectal NETs < 10 mm in diameter were included in this study; they were then divided into three groups: those with cEMR; those with modified EMR (mEMR) involving EMR-C and EMR-L; and those with ESD. The primary endpoint was to evaluate the difference in the complete en bloc resection rate. The secondary endpoint was to investigate differences in procedure time and complications. RESULTS Among the three groups, a significant difference was found in procedure time (cEMR vs ESD, P < .01; mEMR vs ESD, P < .01), en bloc resection rate (cEMR vs mEMR, P = .015), tumor size (mEMR vs ESD, P < .01), percentage of tumor diameter ≥ 5 mm (mEMR vs ESD, P < .01), and complete en bloc resection rate (cEMR vs mEMR, P = .014). Meanwhile, no significant difference was noted in terms of complication rate among the three groups. CONCLUSION The mEMR was the most suitable resection method for rectal NETs < 10 mm with respect to the risks and benefits from procedure-related factors, such as complete en bloc resection rate, procedure time, and complication rate.
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Maione F, Chini A, Milone M, Gennarelli N, Manigrasso M, Maione R, Cassese G, Pagano G, Tropeano FP, Luglio G, De Palma GD. Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs). Diagnostics (Basel) 2021; 11:diagnostics11050771. [PMID: 33923121 PMCID: PMC8145857 DOI: 10.3390/diagnostics11050771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 12/15/2022] Open
Abstract
Rectal neuroendocrine tumors (NETs) are rare, with an incidence of 0.17%, but they represent 12% to 27% of all NETs and 20% of gastrointestinal NETs. Although rectal NETs are uncommon tumors, their incidence has increased over the past few years, and this is probably due to the improvement in detection rates made by advanced endoscopic procedures. The biological behavior of rectal NETs may be different: factors predicting the risk of metastases have been identified, such as size and grade of differentiation. The tendency for metastatic diffusion generally depends on the tumor size, muscular and lymphovascular infiltration, and histopathological differentiation. According to the current European Neuroendocrine Tumor Society (ENETS) guidelines, tumors that are smaller than 10 mm and well differentiated are thought to have a low risk of lymphovascular invasion, and they should be completely removed endoscopically. Rectal NETs larger than 20 mm have a higher risk of involvement of muscularis propria and high metastatic risk and are candidates for surgical resection. There is controversy over rectal NETs of intermediate size, 10–19 mm, where the metastatic risk is considered to be 10–15%: assessment of tumors endoscopically and by endoanal ultrasound should guide treatment in these cases towards endoscopic, transanal, or surgical resection.
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Lee HS, Moon HS, Kwon IS, Park JH, Kim JS, Kang SH, Lee ES, Kim SH, Sung JK, Lee BS, Jeong HY. Comparison of conventional and modified endoscopic mucosal resection methods for the treatment of rectal neuroendocrine tumors. Surg Endosc 2020; 35:6055-6065. [PMID: 33094828 DOI: 10.1007/s00464-020-08097-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM Small rectal neuroendocrine tumors (NETs) confined to the submucosa are endoscopically resectable. Because most rectal NETs are submucosal tumors, conventional endoscopic mucosal resection (cEMR) may not result in a complete resection. This study investigated whether modified EMRs, namely endoscopic submucosal resection with ligation (ESMR-L), EMR with precutting (EMR-P), and strip biopsy are superior to cEMR for achieving histologically complete resection (HCR) of rectal NETs. METHODS Medical records of 215 patients who were treated with endoscopic resections for rectal NETs between January 2011 and July 2019 were retrospectively enrolled. Of the patients, 110, 33, 29, and 43 underwent cEMR, ESMR-L, EMR-P, and strip biopsy, respectively. For each method, HCR and en bloc resection rates, procedure times, and complication rates were measured. RESULTS HCR was achieved with cEMR, EMR-P, ESMR-L, and strip biopsies for 74.5%, 90.9%, 93.1%, and 90.7% of cases, respectively. The HCR rate for cEMR was inferior to those of the modified EMRs (p = 0.045 for cEMR vs. EMR-P; p = 0.031 for cEMR vs. ESMR-L; p = 0.027 for cEMR vs. strip biopsy). Among the three modified EMRs, there was no significant difference in achieving HCR (p = 1.000). En bloc resection (p = 0.096) and complication rates (p = 0.071) were not significantly different among the four EMR methods, although EMR-P required the longest procedure time (p = 0.000). CONCLUSIONS All three modified EMRs are superior to cEMR and are equally effective for achieving HCR of rectal NETs.
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Affiliation(s)
- Hee Sung Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hee Seok Moon
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, 35015, South Korea
| | - Jae Ho Park
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Ju Seok Kim
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Sun Hyung Kang
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Eaum Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Seok Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Jae Kyu Sung
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Byung Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hyun Yong Jeong
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
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Lee J, Park YE, Choi JH, Heo NY, Park J, Park SH, Moon YS, Nam KH, Kim TO. Comparison between cap-assisted and ligation-assisted endoscopic mucosal resection for rectal neuroendocrine tumors. Ann Gastroenterol 2020; 33:385-390. [PMID: 32624659 PMCID: PMC7315720 DOI: 10.20524/aog.2020.0485] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/05/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Modified endoscopic mucosal resection (EMR) is considered a treatment option for rectal neuroendocrine tumors (NETs) <10 mm in diameter. In this study, we evaluated the clinical outcomes of cap-assisted EMR (EMR-C) and EMR with a ligating device (EMR-L). Methods: We retrospectively analyzed 158 patients with 162 rectal NETs treated endoscopically at a single Korean tertiary hospital between March 2010 and November 2017. We evaluated the rates of endoscopic en bloc resection, histologic complete resection, and procedural complications according to the treatment method. Results: Among 162 rectal NETs, 42 were treated with EMR-C and 120 with EMR-L. The endoscopic en bloc resection rate was higher in the EMR-L group than in the EMR-C group (100% vs. 92.9%, P=0.003). A trend was observed towards a superior histologic complete resection rate in the EMR-L group, but it was not statistically significant (92.5% vs. 83.3%, P=0.087). There were no significant differences in procedural complications (P=0.870). In a multivariate analysis, a tumor located ≥10 cm from the anal verge was related to histologic incomplete resection (P=0.039). Conclusion: EMR-L may be the preferable treatment method, considering both endoscopic en bloc resection rate and histologic complete resection rate.
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Affiliation(s)
- Jin Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Jin Lee, Yong Eun Park, Joon Hyuk Choi, Nae-Yun Heo, Jongha Park, Seung Ha Park, Young Soo Moon, Tae Oh Kim)
| | - Yong Eun Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Jin Lee, Yong Eun Park, Joon Hyuk Choi, Nae-Yun Heo, Jongha Park, Seung Ha Park, Young Soo Moon, Tae Oh Kim)
| | - Joon Hyuk Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Jin Lee, Yong Eun Park, Joon Hyuk Choi, Nae-Yun Heo, Jongha Park, Seung Ha Park, Young Soo Moon, Tae Oh Kim)
| | - Nae-Yun Heo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Jin Lee, Yong Eun Park, Joon Hyuk Choi, Nae-Yun Heo, Jongha Park, Seung Ha Park, Young Soo Moon, Tae Oh Kim)
| | - Jongha Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Jin Lee, Yong Eun Park, Joon Hyuk Choi, Nae-Yun Heo, Jongha Park, Seung Ha Park, Young Soo Moon, Tae Oh Kim)
| | - Seung Ha Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Jin Lee, Yong Eun Park, Joon Hyuk Choi, Nae-Yun Heo, Jongha Park, Seung Ha Park, Young Soo Moon, Tae Oh Kim)
| | - Young Soo Moon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Jin Lee, Yong Eun Park, Joon Hyuk Choi, Nae-Yun Heo, Jongha Park, Seung Ha Park, Young Soo Moon, Tae Oh Kim)
| | - Kyung Han Nam
- Department of Pathology (Kyung Han Nam), Haeundae Paik Hospital, College of Medicine, Inje University, Republic of Korea
| | - Tae Oh Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Jin Lee, Yong Eun Park, Joon Hyuk Choi, Nae-Yun Heo, Jongha Park, Seung Ha Park, Young Soo Moon, Tae Oh Kim)
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de Mestier L, Lorenzo D, Fine C, Cros J, Hentic O, Walter T, Panis Y, Couvelard A, Cadiot G, Ruszniewski P. Endoscopic, transanal, laparoscopic, and transabdominal management of rectal neuroendocrine tumors. Best Pract Res Clin Endocrinol Metab 2019; 33:101293. [PMID: 31326374 DOI: 10.1016/j.beem.2019.101293] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rectal neuroendocrine tumors (RNET) are rare tumors but their prevalence is constantly increasing due to a prolonged survival and rising incidence related to a growing number of colonoscopies and improved knowledge. Their main prognostic determinant is tumor stage. While most RNET are localized, their management should be tailored depending on the presence or absence of the factors predictive of lymph-node metastases including tumor size, endoscopic aspect, T stage, grade and lymphovascular invasion. Endoscopic ultrasonography is the most relevant technique for locoregional assessment. Low-risk RNET can be treated using advanced endoscopic resection techniques or transanal endoscopic microsurgery, in expert centers because they require technicity and experience. Conversely, radical surgery with lymphadenectomy should be proposed in the presence of any pejorative factor. The long-term evolution of RNET remains to be specified, and prospective studies should be conducted in order to determine the relevance of the current management strategies.
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Affiliation(s)
- Louis de Mestier
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France; Université de Paris, France; INSERM UMR1149, Paris, France.
| | - Diane Lorenzo
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France; Université de Paris, France
| | - Caroline Fine
- Department of Digestive Oncology, ENETS Centre of Excellence, Edouard Herriot University Hospital, Lyon, France
| | - Jérôme Cros
- Université de Paris, France; INSERM UMR1149, Paris, France; Department of Pathology, ENETS Centre of Excellence, AP-HP, Bichat/Beaujon Hospital, Clichy, France
| | - Olivia Hentic
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France
| | - Thomas Walter
- Department of Digestive Oncology, ENETS Centre of Excellence, Edouard Herriot University Hospital, Lyon, France
| | - Yves Panis
- Université de Paris, France; Department of Colorectal Surgery, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France
| | - Anne Couvelard
- Université de Paris, France; INSERM UMR1149, Paris, France; Department of Pathology, ENETS Centre of Excellence, AP-HP, Bichat/Beaujon Hospital, Clichy, France
| | - Guillaume Cadiot
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert Debré Hospital and Reims-Champagne-Ardennes University, Reims, France
| | - Philippe Ruszniewski
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France; Université de Paris, France; INSERM UMR1149, Paris, France
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Zhang DG, Luo S, Xiong F, Xu ZL, Li YX, Yao J, Wang LS. Endoloop ligation after endoscopic mucosal resection using a transparent cap: A novel method to treat small rectal carcinoid tumors. World J Gastroenterol 2019; 25:1259-1265. [PMID: 30886508 PMCID: PMC6421235 DOI: 10.3748/wjg.v25.i10.1259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Local endoscopic resection is an effective method for the treatment of small rectal carcinoid tumors, but remnant tumor at the margin after resection remains to be an issue.
AIM To evaluate the efficacy and safety of resection of small rectal carcinoid tumors by endoloop ligation after cap-endoscopic mucosal resection (LC-EMR) using a transparent cap.
METHODS Thirty-four patients with rectal carcinoid tumors of less than 10 mm in diameter were treated by LC-EMR (n = 22) or endoscopic submucosal dissection (ESD) (n = 12) between January 2016 and December 2017. Demographic data, complete resection rates, pathologically complete resection rates, operation duration, and postoperative complications were collected. All cases were followed for 6 to 30 mo.
RESULTS A total of 22 LC-EMR cases and 12 ESD cases were enrolled. The average age was 48.18 ± 12.31 and 46.17 ± 12.57 years old, and the tumor size was 7.23 ± 1.63 mm and 7.50 ± 1.38 mm, respectively, for the LC-EMR and ESD groups. Resection time in the ESD group was longer than that in the LC-EMR group (15.67 ± 2.15 min vs 5.91 ± 0.87 min; P < 0.001). All lesions were completely resected at one time. No perforation or delayed bleeding was observed in either group. Pathologically complete resection (P-CR) rate was 86.36% (19/22) and 91.67% (11/12) in the LC-EMR and ESD groups (P = 0.646), respectively. Two of the three cases with a positive margin in the LC-EMR group received transanal endoscopic microsurgery (TEM) and tumor cells were not identified in the postoperative specimens. The other case with a positive margin chose follow-up without further operation. One case with remnant tumor after ESD received further local ligation treatment. Neither local recurrence nor lymph node metastasis was found during the follow-up period.
CONCLUSION LC-EMR appears to be an efficient and simple method for the treatment of small rectal carcinoid tumors, which can effectively avoid margin remnant tumors.
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Affiliation(s)
- Ding-Guo Zhang
- Department of Gastroenterology, Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen 518020, Guangdong Province, China
| | - Su Luo
- Department of Gastroenterology, Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen 518020, Guangdong Province, China
| | - Feng Xiong
- Department of Gastroenterology, Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen 518020, Guangdong Province, China
| | - Zheng-Lei Xu
- Department of Gastroenterology, Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen 518020, Guangdong Province, China
| | - Ying-Xue Li
- Department of Gastroenterology, Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen 518020, Guangdong Province, China
| | - Jun Yao
- Department of Gastroenterology, Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen 518020, Guangdong Province, China
| | - Li-Sheng Wang
- Department of Gastroenterology, Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen 518020, Guangdong Province, China
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Endoscopic submucosal resection with an endoscopic variceal ligation device for the treatment of rectal neuroendocrine tumors. Int J Colorectal Dis 2018; 33:1703-1708. [PMID: 30167779 DOI: 10.1007/s00384-018-3152-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic resection is recommended for rectal neuroendocrine tumors < 1 cm in diameter; the three techniques (mucosal resection, submucosal dissection, and mucosal resection with variceal ligation device) of endoscopic resection of neuroendocrine tumor were reported; however, the optimal endoscopic technique remains unclear. PURPOSE We compared the efficacy and safety of three endoscopic rectal neuroendocrine tumor resection methods. METHODS We retrospectively enrolled 52 patients with rectal neuroendocrine tumors treated by endoscopy at Aichi Medical University Hospital and Nagoya City University Hospital between May 2003 and June 2017. We compared clinical outcomes in three groups based on the endoscopic treatment method. RESULTS Fifty-two patients underwent endoscopic rectal neuroendocrine tumor treatment (mucosal resection, 14; submucosal dissection, 19; mucosal resection with an endoscopic variceal ligation device, 19). In the endoscopic mucosal resection, submucosal dissection, and mucosal resection with variceal ligation device groups, R0 resection occurred in 50.0, 94.7, and 89.5%, respectively (mucosal resection vs. mucosal resection with variceal ligation device, p < 0.05; mucosal resection vs. submucosal dissection, p < 0.01), while the median procedure times were 6.5, 43, and 6.0 min, respectively (submucosal dissection vs. mucosal resection with variceal ligation device procedure times, p < 0.01; mucosal resection vs. submucosal resection procedure times, p < 0.01). Postoperative bleeding occurred after endoscopic mucosal resection (1/14) and endoscopic submucosal dissection (4/19), but not after endoscopic mucosal resection with a ligation device. CONCLUSION Endoscopic mucosal resection with an endoscopic variceal ligation device was a safe, effective treatment for rectal neuroendocrine tumors.
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Bertani E, Ravizza D, Milione M, Massironi S, Grana CM, Zerini D, Piccioli AN, Spinoglio G, Fazio N. Neuroendocrine neoplasms of rectum: A management update. Cancer Treat Rev 2018; 66:45-55. [PMID: 29684743 DOI: 10.1016/j.ctrv.2018.04.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 02/07/2023]
Abstract
The estimated annual incidence of R-NENs is 1.04 per 100,000 persons although the real incidence may be underestimated, as not all R-NEN are systematically reported in registers. Also the prevalence has increased substantially, reflecting the rising incidence and indolent nature of R-NENs, showing the highest prevalence increase among all site of origin of NENs. The size of the tumor reveals the behavior of R-NENs where the risk for metastatic spread increases for lesions > 10 mm. Applying the WHO 2010 grading system to whole NENs originating in the gastroenteropancreatic system, R-NENs are classified as Well-Differentiated Neuroendocrine Tumors (WD-NET), which contain NET G1 and NET G2, and Poorly-Differentiated Carcinomas (PD-NEC) enclosing only G3 neoplasms for which the term carcinoma is applied. The treatment is endoscopic resection in most cases: conventional polypectomy or endoscopic mucosal resection (EMR) for smaller lesions or endoscopic submucosal resection with a ligation device (ESMR-L), cap-assisted EMR (EMR-C) and endoscopic submucosal dissection (ESD). However it is important to know when the endoscopic treatment is not enough, and surgical treatment is indicated, or when the latter could be unnecessary. For PD-NECs, it has recently been demonstrated that chemoradiotherapy is associated with a similar long-term survival to that obtained with surgery. As well, new targeted-agents chemotherapy may be indicated for metastatic WD-NETs.
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Affiliation(s)
- Emilio Bertani
- Division of Gastrointestinal Surgery, European Institute of Oncology, Milano, Italy.
| | - Davide Ravizza
- Division of Endoscopy, European Institute of Oncology, Milano, Italy
| | - Massimo Milione
- Department of Pathology and Laboratory Medicine, IRCCS Foundation National Cancer Institute, Milano, Italy
| | - Sara Massironi
- Division of Gastroenterology, Ospedale Policlinico, Milano, Italy
| | - Chiara Maria Grana
- Division of Nuclear Medicine, European Institute of Oncology, Milano, Italy
| | - Dario Zerini
- Division of Radiotherapy, European Institute of Oncology, Milano, Italy
| | | | - Giuseppe Spinoglio
- Division of Gastrointestinal Surgery, European Institute of Oncology, Milano, Italy
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milano, Italy
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Abstract
Endoscopic mucosal resection (EMR) is a non-invasive alternative to surgery that is now frequently used for resection of early lesions in both upper and lower parts of the gastrointestinal (GI) tract. One of the main advantages of these techniques is providing tissue for histopathological examination. Pathological examination of endoscopically resected specimens of GI tract is a crucial component of these procedures and is useful for prediction of both the risk of metastasis and lymph node involvement.
As the first step, it is very important for the pathologist to handle the EMR gross specimen in the correct way: it should be oriented, and then the margins should be labeled and inked accurately before fixation.
In the second step, the EMR pathological report should include all the detailed information about the diagnosis, grading, depth of invasion (mucosa only or submucosal involvement), status of the margins, and the presence or absence of lymphovascular invasion.
The current literature (PubMed and Google Scholar) was searched for the words "endoscopic mucosal resection" to find all relevant publications about this technique with emphasis on the pathologist responsibilities.
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Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran ; Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - David A Owen
- Deptartment of Pathology, Vancouver General Hospital and University of British Columbia, Vancouver, BC, Canada
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Lee SI, Lim BH, Heo WG, Kim YJ, Kim TH. Successful Removal of a Large Common Bile Duct Stone by Using Direct Peroral Cholangioscopy and Laser Lithotripsy in a Patient with Severe Kyphosis. Clin Endosc 2016; 49:395-8. [PMID: 27000425 PMCID: PMC4977743 DOI: 10.5946/ce.2015.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/13/2016] [Accepted: 02/19/2016] [Indexed: 12/28/2022] Open
Abstract
A 75-year-old woman with hypertension presented with acute suppurative cholangitis. Chest radiography revealed severe kyphosis. Abdominal computed tomography revealed a large stone impacted in the common bile duct (CBD). The patient underwent emergent endoscopic retrograde cholangiopancreatography, and cholangiography revealed a large stone (7×3 cm) in the CBD that could not be captured using a large basket. We could not use the percutaneous approach for stone fragmentation by using a cholangioscope because of severe degenerative kyphosis. Finally, we performed holmium laser lithotripsy under peroral cholangioscopy by using an ultraslim endoscope, and the large stone in the CBD was successfully fragmented and removed without complications.
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Affiliation(s)
- Song I Lee
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Byung Hun Lim
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Won Gak Heo
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Young Jun Kim
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Tae Hyeon Kim
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
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