Efficacy of endoscopic submucosal resection with a ligation device for removing small rectal carcinoid tumor compared with endoscopic mucosal resection: analysis of 100 cases.

Aim:   Conventional endoscopic mucosal resection (EMR) of carcinoid tumors is often associated with involvement of the resection margin, which necessitates further intervention. Endoscopic submucosal resection with a ligation device (ESMR-L) is a novel technique for the removal of carcinoid tumors. The aim of the present study was to compare the clinical usefulness of endoscopic submucosal resection with a ligation device with that of EMR for the complete resection of rectal carcinoid tumors.

Methods:   Between January 2001 and October 2010, a total of 100 patients with 100 rectal carcinoid tumors that were estimated to be 10 mm or less in diameter and that were resected either using ESMR-L or EMR were recruited for this study. The complete resection rate and complications associated with these two procedures were analyzed.

Results:   Forty-five out of 100 lesions were resected using ESMR-L, and 55 lesions were resected using EMR. Histopathologically, all tumors were free from lymphovascular and perineural invasion. The overall ESMR-L complete resection rate was higher than that of EMR (93.3% vs 65.5%, respectively, P = 0.001). Furthermore, the location of the tumors had no influence on the complete resection rate when ESMR-L was carried out, in contrast to the results of EMR. The procedure-related variables of procedure time and complication rate were not significantly different between the two groups.

Conclusion:   ESMR-L is a significantly superior modality to EMR for the complete removal of small rectal carcinoid tumors that are 10 mm or less in diameter.