Endoloop ligation after endoscopic mucosal resection using a transparent cap: A novel method to treat small rectal carcinoid tumors

World J Gastroenterol. 2019 Mar 14;25(10):1259-1265. doi: 10.3748/wjg.v25.i10.1259.

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.

Keywords: Endoscopic mucosal resection; Endoscopic submucosal dissection; Ligation; Rectal carcinoid.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Carcinoid Tumor / diagnostic imaging
  • Carcinoid Tumor / pathology
  • Carcinoid Tumor / surgery*
  • Endoscopic Mucosal Resection / adverse effects
  • Endoscopic Mucosal Resection / instrumentation*
  • Endoscopic Mucosal Resection / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Intestinal Mucosa / diagnostic imaging
  • Intestinal Mucosa / pathology
  • Intestinal Mucosa / surgery
  • Intestinal Neoplasms / diagnostic imaging
  • Intestinal Neoplasms / pathology
  • Intestinal Neoplasms / surgery*
  • Ligation / adverse effects
  • Ligation / instrumentation
  • Ligation / methods
  • Lymphatic Metastasis / prevention & control
  • Male
  • Margins of Excision
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Recurrence, Local / prevention & control
  • Operative Time
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Proctoscopy / adverse effects
  • Proctoscopy / instrumentation*
  • Proctoscopy / methods
  • Rectal Neoplasms / diagnostic imaging
  • Rectal Neoplasms / pathology
  • Rectal Neoplasms / surgery*
  • Rectum / diagnostic imaging
  • Rectum / pathology
  • Rectum / surgery
  • Retrospective Studies
  • Treatment Outcome

Supplementary concepts

  • Carcinoid Tumors, Intestinal