Endoloop ligation after endoscopic mucosal resection using a transparent cap: A novel method to treat small rectal carcinoid tumors
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摘要
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 was48.18 ± 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.
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 was48.18 ± 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.
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 was48.18 ± 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.
引文
1 Koura AN,Giacco GG,Curley SA,Skibber JM,Feig BW,Ellis LM.Carcinoid tumors of the rectum:effect of size,histopathology,and surgical treatment on metastasis free survival.Cancer 1997;79:1294-1298[PMID:9083149 DOI:10.1002/(SICI)1097-0142(19970401)79:7<1294::AID-CNCR4>3.0.CO;2-H]
2 Shields CJ,Tiret E,Winter DC;International Rectal Carcinoid Study Group.Carcinoid tumors of the rectum:a multi-institutional international collaboration.Ann Surg 2010;252:750-755[PMID:21037430DOI:10.1097/SLA.0b013e3181fb8df6]
3 Yoshikane H,Goto H,Niwa Y,Matsui M,Ohashi S,Suzuki T,Hamajima E,Hayakawa T.Endoscopic resection of small duodenal carcinoid tumors with strip biopsy technique.Gastrointest Endosc 1998;47:466-470[PMID:9647370 DOI:10.1016/S0016-5107(98)70246-9]
4 Lee DS,Jeon SW,Park SY,Jung MK,Cho CM,Tak WY,Kweon YO,Kim SK.The feasibility of endoscopic submucosal dissection for rectal carcinoid tumors:comparison with endoscopic mucosal resection.Endoscopy 2010;42:647-651[PMID:20669076 DOI:10.1055/s-0030-1255591]
5 Zhang D,Lin Q,Shi R,Wang L,Yao J,Tian Y.Ligation-assisted endoscopic submucosal resection with apical mucosal incision to treat gastric subepithelial tumors originating from the muscularis propria.Endoscopy 2018;50:1180-1185[PMID:29913532 DOI:10.1055/a-0625-6326]
6 Yague AS,Shah JN,Nguyentang T,Soetikno R,Binmoeller KF.Simplified treatment of gastric GISTs by endolooping without resection:“loop-and-let-go”.Gastrointest Endosc 2009;69:AB174-AB175[DOI:10.1016/j.gie.2009.03.337]
7 Zhou PH,Yao LQ,Qin XY,Xu MD,Zhong YS,Chen WF,Ma LL,Zhang YQ,Qin WZ,Cai MY,Ji Y.Advantages of endoscopic submucosal dissection with needle-knife over endoscopic mucosal resection for small rectal carcinoid tumors:a retrospective study.Surg Endosc 2010;24:2607-2612[PMID:20361212DOI:10.1007/s00464-010-1016-z]
8 Matsumoto T,Iida M,Suekane H,Tominaga M,Yao T,Fujishima M.Endoscopic ultrasonography in rectal carcinoid tumors:contribution to selection of therapy.Gastrointest Endosc 1991;37:539-542[PMID:1936832 DOI:10.1016/S0016-5107(91)70824-9]
9 Koyama N,Yoshida H,Nihei M,Sakonji M,Wachi E.Endoscopic Resection of Rectal Carcinoids Using Double Snare Polypectomy Technique.Dig Endosc 1998;10:42-45[DOI:10.1111/j.1443-1661.1998.tb00538.x]
10 Ono A,Fujii T,Saito Y,Matsuda T,Lee DT,Gotoda T,Saito D.Endoscopic submucosal resection of rectal carcinoid tumors with a ligation device.Gastrointest Endosc 2003;57:583-587[PMID:12665777DOI:10.1067/mge.2003.142]
11 Moon JH,Kim JH,Park CH,Jung JO,Shin WG,Kim JP,Kim KO,Hahn T,Yoo KS,Park SH,Park CK.Endoscopic submucosal resection with double ligation technique for treatment of small rectal carcinoid tumors.Endoscopy 2006;38:511-514[PMID:16767589 DOI:10.1055/s-2006-925074]
12 Lee HJ,Kim SB,Shin CM,Seo AY,Lee DH,Kim N,Park YS,Yoon H.A comparison of endoscopic treatments in rectal carcinoid tumors.Surg Endosc 2016;30:3491-3498[PMID:26514133 DOI:10.1007/s00464-015-4637-4]
13 Wang X,Xiang L,Li A,Han Z,Li Y,Wang Y,Guo Y,Zuang K,Yan Q,Zhong J,Xiong J,Yang H,Liu S.Endoscopic submucosal dissection for the treatment of rectal carcinoid tumors 7-16 mm in diameter.Int J Colorectal Dis 2015;30:375-380[PMID:25596026 DOI:10.1007/s00384-014-2117-2]
14 Chen R,Liu X,Sun S,Wang S,Ge N,Wang G,Guo J.Comparison of Endoscopic Mucosal Resection With Circumferential Incision and Endoscopic Submucosal Dissection for Rectal Carcinoid Tumor.Surg Laparosc Endosc Percutan Tech 2016;26:e56-e61[PMID:27213787 DOI:10.1097/SLE.0000000000000266]
15 Zhang D,Shi R,Yao J,Zhang R,Xu Z,Wang L.Treatment of massive esophageal variceal bleeding by Sengstaken-Blackmore tube compression and intensive endoscopic detachable mini-loop ligation:a retrospective study in 83 patients.Hepatogastroenterology 2015;62:77-81[PMID:25911872]
2 Shields CJ,Tiret E,Winter DC;International Rectal Carcinoid Study Group.Carcinoid tumors of the rectum:a multi-institutional international collaboration.Ann Surg 2010;252:750-755[PMID:21037430DOI:10.1097/SLA.0b013e3181fb8df6]
3 Yoshikane H,Goto H,Niwa Y,Matsui M,Ohashi S,Suzuki T,Hamajima E,Hayakawa T.Endoscopic resection of small duodenal carcinoid tumors with strip biopsy technique.Gastrointest Endosc 1998;47:466-470[PMID:9647370 DOI:10.1016/S0016-5107(98)70246-9]
4 Lee DS,Jeon SW,Park SY,Jung MK,Cho CM,Tak WY,Kweon YO,Kim SK.The feasibility of endoscopic submucosal dissection for rectal carcinoid tumors:comparison with endoscopic mucosal resection.Endoscopy 2010;42:647-651[PMID:20669076 DOI:10.1055/s-0030-1255591]
5 Zhang D,Lin Q,Shi R,Wang L,Yao J,Tian Y.Ligation-assisted endoscopic submucosal resection with apical mucosal incision to treat gastric subepithelial tumors originating from the muscularis propria.Endoscopy 2018;50:1180-1185[PMID:29913532 DOI:10.1055/a-0625-6326]
6 Yague AS,Shah JN,Nguyentang T,Soetikno R,Binmoeller KF.Simplified treatment of gastric GISTs by endolooping without resection:“loop-and-let-go”.Gastrointest Endosc 2009;69:AB174-AB175[DOI:10.1016/j.gie.2009.03.337]
7 Zhou PH,Yao LQ,Qin XY,Xu MD,Zhong YS,Chen WF,Ma LL,Zhang YQ,Qin WZ,Cai MY,Ji Y.Advantages of endoscopic submucosal dissection with needle-knife over endoscopic mucosal resection for small rectal carcinoid tumors:a retrospective study.Surg Endosc 2010;24:2607-2612[PMID:20361212DOI:10.1007/s00464-010-1016-z]
8 Matsumoto T,Iida M,Suekane H,Tominaga M,Yao T,Fujishima M.Endoscopic ultrasonography in rectal carcinoid tumors:contribution to selection of therapy.Gastrointest Endosc 1991;37:539-542[PMID:1936832 DOI:10.1016/S0016-5107(91)70824-9]
9 Koyama N,Yoshida H,Nihei M,Sakonji M,Wachi E.Endoscopic Resection of Rectal Carcinoids Using Double Snare Polypectomy Technique.Dig Endosc 1998;10:42-45[DOI:10.1111/j.1443-1661.1998.tb00538.x]
10 Ono A,Fujii T,Saito Y,Matsuda T,Lee DT,Gotoda T,Saito D.Endoscopic submucosal resection of rectal carcinoid tumors with a ligation device.Gastrointest Endosc 2003;57:583-587[PMID:12665777DOI:10.1067/mge.2003.142]
11 Moon JH,Kim JH,Park CH,Jung JO,Shin WG,Kim JP,Kim KO,Hahn T,Yoo KS,Park SH,Park CK.Endoscopic submucosal resection with double ligation technique for treatment of small rectal carcinoid tumors.Endoscopy 2006;38:511-514[PMID:16767589 DOI:10.1055/s-2006-925074]
12 Lee HJ,Kim SB,Shin CM,Seo AY,Lee DH,Kim N,Park YS,Yoon H.A comparison of endoscopic treatments in rectal carcinoid tumors.Surg Endosc 2016;30:3491-3498[PMID:26514133 DOI:10.1007/s00464-015-4637-4]
13 Wang X,Xiang L,Li A,Han Z,Li Y,Wang Y,Guo Y,Zuang K,Yan Q,Zhong J,Xiong J,Yang H,Liu S.Endoscopic submucosal dissection for the treatment of rectal carcinoid tumors 7-16 mm in diameter.Int J Colorectal Dis 2015;30:375-380[PMID:25596026 DOI:10.1007/s00384-014-2117-2]
14 Chen R,Liu X,Sun S,Wang S,Ge N,Wang G,Guo J.Comparison of Endoscopic Mucosal Resection With Circumferential Incision and Endoscopic Submucosal Dissection for Rectal Carcinoid Tumor.Surg Laparosc Endosc Percutan Tech 2016;26:e56-e61[PMID:27213787 DOI:10.1097/SLE.0000000000000266]
15 Zhang D,Shi R,Yao J,Zhang R,Xu Z,Wang L.Treatment of massive esophageal variceal bleeding by Sengstaken-Blackmore tube compression and intensive endoscopic detachable mini-loop ligation:a retrospective study in 83 patients.Hepatogastroenterology 2015;62:77-81[PMID:25911872]