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Clinical utility of endoscopic submucosal dissection using the pocket-creation method with a HookKnife and preoperative evaluation by endoscopic ultrasonography for the treatment of rectal neuroendocrine tumors

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Abstract

Background

Various endoscopic methods have been developed to remove small rectal neuroendocrine tumors (NETs). This study aimed to evaluate the clinical utility of endoscopic submucosal dissection using the pocket-creation method (ESD-PCM) with a HookKnife, following preoperative evaluation by endoscopic ultrasonography (EUS), for the treatment of rectal NETs.

Methods

We analyzed retrospectively consecutive patients who underwent ESD-PCM with a HookKnife for the removal of rectal NETs, with a size less than 10 mm, at Mie University Hospital between June 2015 and December 2019. All the rectal NETs were resected by ESD-PCM with a HookKnife. The R0 resection rate, procedure time, adverse event rate, diagnostic accuracy of tumor size and invasion depth evaluated by preoperative EUS, and follow-up outcome were evaluated retrospectively.

Results

The study group comprised 12 patients with 12 resected lesions. The median tumor size of the resected specimens was 5 mm and the size and invasion depth of each tumor was approximately equal to that predicted by preoperative EUS. R0 resection was achieved in all cases, without adverse events. The median procedure time was 50.5 min, which did not differ from previous studies. No recurrence was observed during the median follow-up period of 34.4 months (range, 5.2–60.0 months).

Conclusions

ESD-PCM with a HookKnife provides a favorable clinical utility for removing rectal NETs, with high R0 resection rate and good follow-up outcome. In addition, EUS is useful for evaluating preoperatively the size and invasion depth of rectal NETs.

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References

  1. Ito T, Sasano H, Tanaka M, Osamura RY, Sasaki I, Kimura W, Takano K, Obara T, Ishibashi M, Nakao K, Doi R, Shimatsu A, Nishida T, Komoto I, Hirata Y, Nakamura K, Igarashi H, Jensen RT, Wiedenmann B, Imamura M (2010) Epidemiological study of gastroenteropancreatic neuroendocrine tumors in Japan. J Gastroenterol 45:234–243

  2. Ito T, Igarashi H, Nakamura K, Sasano H, Okusaka T, Takano K, Komoto I, Tanaka M, Imamura M, Jensen RT, Takayanagi R, Shimatsu A (2015) Epidemiological trends of pancreatic and gastrointestinal neuroendocrine tumors in Japan: a nationwide survey analysis. J Gastroenterol 50:58–64

    Article  Google Scholar 

  3. Scherubl H (2009) Rectal carcinoids are on the rise: early detection by screening endoscopy. Endoscopy 41:162–165

    Article  CAS  Google Scholar 

  4. Mashimo Y, Matsuda T, Uraoka T, Saito Y, Sano Y, Fu K, Kozu T, Ono A, Fujii T, Saito D (2008) Endoscopic submucosal resection with a ligation device is an effective and safe treatment for carcinoid tumors in the lower rectum. J Gastroenterol Hepatol 23:218–221

    Article  Google Scholar 

  5. Park CH, Cheon JH, Kim JO, Shin JE, Jang BI, Shin SJ, Jeen YT, Lee SH, Ji JS, Han DS, Jung SA, Park DI, Baek IH, Kim SH, Chang DK (2011) Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread. Endoscopy 43:790–795

    Article  CAS  Google Scholar 

  6. Kunz PL, Reidy-Lagunes D, Anthony LB, Bertino EM, Brendtro K, Chan JA, Chen H, Jensen RT, Kim MK, Klimstra DS, Kulke MH, Liu EH, Metz DC, Phan AT, Sippel RS, Strosberg JR, Yao JC, North American Neuroendocrine Tumor S (2013) Consensus guidelines for the management and treatment of neuroendocrine tumors. Pancreas 42:557–577

    Article  Google Scholar 

  7. Ramage JK, De Herder WW, Delle Fave G, Ferolla P, Ferone D, Ito T, Ruszniewski P, Sundin A, Weber W, Zheng-Pei Z, Taal B, Pascher A, all other Vienna Consensus Conference participants (2016) ENETS Consensus Guidelines Update for Colorectal Neuroendocrine Neoplasms. Neuroendocrinology 103:139–143

  8. Japanese Neuroendocirne Society (2019) Clinical practice guidelines for gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN) 2019, 2nd edn. Kanehara Shuppan, Tokyo

    Google Scholar 

  9. Iishi H, Tatsuta M, Yano H, Narahara H, Iseki K, Ishiguro S (1996) More effective endoscopic resection with a two-channel colonoscope for carcinoid tumors of the rectum. Dis Colon Rectum 39:1438–1439

    Article  CAS  Google Scholar 

  10. Chen HT, Xu GQ, Teng XD, Chen YP, Chen LH, Li YM (2014) Diagnostic accuracy of endoscopic ultrasonography for rectal neuroendocrine neoplasms. World J Gastroenterol 20:10470–10477

    Article  Google Scholar 

  11. Kim HH, Park SJ, Lee SH, Park HU, Song CS, Park MI, Moon W (2012) Efficacy of endoscopic submucosal resection with a ligation device for removing small rectal carcinoid tumor compared with endoscopic mucosal resection: analysis of 100 cases. Dig Endosc 24:159–163

    Article  Google Scholar 

  12. Ebi M, Nakagawa S, Yamaguchi Y, Tamura Y, Izawa S, Hijikata Y, Shimura T, Funaki Y, Ogasawara N, Sasaki M, Joh T, Kasugai K (2018) Endoscopic submucosal resection with an endoscopic variceal ligation device for the treatment of rectal neuroendocrine tumors. Int J Colorectal Dis 33:1703–1708

    Article  Google Scholar 

  13. Lee WH, Kim SW, Lim CH, Kim JS, Cho YK, Lee IS, Choi MG, Choi KY (2013) Efficacy of endoscopic mucosal resection using a dual-channel endoscope compared with endoscopic submucosal dissection in the treatment of rectal neuroendocrine tumors. Surg Endosc 27:4313–4318

    Article  Google Scholar 

  14. Imada-Shirakata Y, Sakai M, Kajiyama T, Kin G, Inoue K, Torii A, Kishimoto H, Ueda S, Okuma M (1997) Endoscopic resection of rectal carcinoid tumors using aspiration lumpectomy. Endoscopy 29:34–38

    Article  CAS  Google Scholar 

  15. Nagai T, Torishima R, Nakashima H, Ookawara H, Uchida A, Kai S, Sato R, Murakami K, Fujioka T (2004) Saline-assisted endoscopic resection of rectal carcinoids: cap aspiration method versus simple snare resection. Endoscopy 36:202–205

    Article  CAS  Google Scholar 

  16. Park SB, Kim HW, Kang DH, Choi CW, Kim SJ, Nam HS (2015) Advantage of endoscopic mucosal resection with a cap for rectal neuroendocrine tumors. World J Gastroenterol 21:9387–9393

    Article  Google Scholar 

  17. Ono A, Fujii T, Saito Y, Matsuda T, Lee DT, Gotoda T, Saito D (2003) Endoscopic submucosal resection of rectal carcinoid tumors with a ligation device. Gastrointest Endosc 57:583–587

    Article  Google Scholar 

  18. Lim HK, Lee SJ, Baek DH, Park DY, Lee BE, Park EY, Park JW, Kim GH, Song GA (2019) Resectability of rectal neuroendocrine tumors using endoscopic mucosal resection with a ligation band device and endoscopic submucosal dissection. Gastroenterol Res Pract 2019:8425157

    Article  Google Scholar 

  19. Takita M, Sakai E, Nakao T, Kimoto Y, Ishii R, Konishi T, Ueno S, Kanda K, Negishi R, Muramoto T, Hashimoto H, Morikawa T, Matsuhashi N, Ohata K (2019) Clinical outcomes of patients with small rectal neuroendocrine tumors treated using endoscopic submucosal resection with a ligation device. Digestion 99:72–78

    Article  Google Scholar 

  20. Yamashina T, Tumura T, Maruo T, Matsumae T, Yoshida H, Tanke G, Taki M, Fukuhara M, Kimura Y, Sakamoto A, Henmi S, Sawai Y, Saito S, Nishijima N, Nasu A, Komekado H, Asada M, Kita R, Kimura T, Osaki Y (2018) Underwater endoscopic mucosal resection: a new endoscopic method for resection of rectal neuroendocrine tumor grade 1 (carcinoid) </= 10 mm in diameter. Endosc Int Open 6:E111–E114

    Article  Google Scholar 

  21. Park SS, Han KS, Kim B, Chang Kim B, Hong CW, Sohn DK, Chang HJ (2020) Comparison of underwater endoscopic mucosal resection and endoscopic submucosal dissection of rectal neuroendocrine tumors (with videos). Gastrointest Endosc 91:1164–1171

    Article  Google Scholar 

  22. Huang J, Lu ZS, Yang YS, Yuan J, Wang XD, Meng JY, Du H, Wang HB (2014) Endoscopic mucosal resection with circumferential incision for treatment of rectal carcinoid tumours. World J Surg Oncol 12:23

    Article  Google Scholar 

  23. Zhang J, Liu M, Li H, Chen J, Su H, Zheng J, Lin G, Lei X (2018) Comparison of endoscopic therapies for rectal carcinoid tumors: Endoscopic mucosal resection with circumferential incision versus endoscopic submucosal dissection. Clin Res Hepatol Gastroenterol 42:24–30

    Article  Google Scholar 

  24. Hamada YTK, Kosaka R, Kadowaki S, Imoto I, Toyoda H (2007) Two cases with rectal carcinoid tumors resected by endoscopic submucosal dissection using hook knife [in Japanese with English abstract]. Gastroenterol Endosc 49:1273–1280

    Google Scholar 

  25. Lee DS, Jeon SW, Park SY, Jung MK, Cho CM, Tak WY, Kweon YO, Kim SK (2010) The feasibility of endoscopic submucosal dissection for rectal carcinoid tumors: comparison with endoscopic mucosal resection. Endoscopy 42:647–651

    Article  CAS  Google Scholar 

  26. Park HW, Byeon JS, Park YS, Yang DH, Yoon SM, Kim KJ, Ye BD, Myung SJ, Yang SK, Kim JH (2010) Endoscopic submucosal dissection for treatment of rectal carcinoid tumors. Gastrointest Endosc 72:143–149

    Article  Google Scholar 

  27. Yamaguchi N, Isomoto H, Nishiyama H, Fukuda E, Ishii H, Nakamura T, Ohnita K, Hayashi T, Kohno S, Nakao K, Shikuwa S (2010) Endoscopic submucosal dissection for rectal carcinoid tumors. Surg Endosc 24:504–508

    Article  Google Scholar 

  28. Hamada Y, Tanaka K, Tano S, Katsurahara M, Kosaka R, Noda T, Aoki M, Toyoda H, Takei Y, Katayama N (2012) Usefulness of endoscopic submucosal dissection for the treatment of rectal carcinoid tumors. Eur J Gastroenterol Hepatol 24:770–774

    Article  Google Scholar 

  29. Chen T, Yao LQ, Xu MD, Zhang YQ, Chen WF, Shi Q, Cai SL, Chen YY, Xie YH, Ji Y, Chen SY, Zhou PH, Zhong YS (2016) Efficacy and safety of endoscopic submucosal dissection for colorectal carcinoids. Clin Gastroenterol Hepatol 14:575–581

    Article  Google Scholar 

  30. Kobori I, Katayama Y, Kitagawa T, Fujimoto Y, Oura R, Toyoda K, Kusano Y, Ban S, Tamano M (2019) Pocket creation method of endoscopic submucosal dissection to ensure curative resection of rectal neuroendocrine tumors. GE Port J Gastroenterol 26:207–211

    Article  Google Scholar 

  31. Oyama T, Tomori A, Hotta K, Morita S, Kominato K, Tanaka M, Miyata Y (2005) Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 3:S67-70

    Article  Google Scholar 

  32. Pan J, Zhang X, Shi Y, Pei Q (2018) Endoscopic mucosal resection with suction vs. endoscopic submucosal dissection for small rectal neuroendocrine tumors: a meta-analysis. Scand J Gastroenterol 53:1139–1145

    Article  Google Scholar 

  33. Hayashi Y, Sunada K, Takahashi H, Shinhata H, Lefor AT, Tanaka A, Yamamoto H (2014) Pocket-creation method of endoscopic submucosal dissection to achieve en bloc resection of giant colorectal subpedunculated neoplastic lesions. Endoscopy 46 Suppl 1 UCTN:E421–422

  34. Hayashi Y, Miura Y, Yamamoto H (2015) Pocket-creation method for the safe, reliable, and efficient endoscopic submucosal dissection of colorectal lateral spreading tumors. Dig Endosc 27:534–535

    Article  Google Scholar 

  35. Sakamoto H, Hayashi Y, Miura Y, Shinozaki S, Takahashi H, Fukuda H, Okada M, Ino Y, Takezawa T, Sunada K, Lefor AK, Yamamoto H (2017) Pocket-creation method facilitates endoscopic submucosal dissection of colorectal laterally spreading tumors, non-granular type. Endosc Int Open 5:E123–E129

    Article  Google Scholar 

  36. Kanamori A, Nakano M, Kondo M, Tanaka T, Abe K, Suzuki T, Kino H, Kaneko Y, Tsuchida C, Tsuchida K, Yoshitake N, Tominaga K, Imai Y, Hiraishi H (2017) Clinical effectiveness of the pocket-creation method for colorectal endoscopic submucosal dissection. Endosc Int Open 5:E1299–E1305

    Article  Google Scholar 

  37. Takezawa T, Hayashi Y, Shinozaki S, Sagara Y, Okada M, Kobayashi Y, Sakamoto H, Miura Y, Sunada K, Lefor AK, Yamamoto H (2019) The pocket-creation method facilitates colonic endoscopic submucosal dissection (with video). Gastrointest Endosc 89:1045–1053

    Article  Google Scholar 

  38. Ishii N, Horiki N, Itoh T, Maruyama M, Matsuda M, Setoyama T, Suzuki S, Uchida S, Uemura M, Iizuka Y, Fukuda K, Suzuki K, Fujita Y (2010) Endoscopic submucosal dissection and preoperative assessment with endoscopic ultrasonography for the treatment of rectal carcinoid tumors. Surg Endosc 24:1413–1419

    Article  Google Scholar 

  39. Suzuki S, Ishii N, Uemura M, Deshpande GA, Matsuda M, Iizuka Y, Fukuda K, Suzuki K, Fujita Y (2012) Endoscopic submucosal dissection (ESD) for gastrointestinal carcinoid tumors. Surg Endosc 26:759–763

    Article  Google Scholar 

  40. Moon CM, Huh KC, Jung SA, Park DI, Kim WH, Jung HM, Koh SJ, Kim JO, Jung Y, Kim KO, Kim JW, Yang DH, Shin JE, Shin SJ, Kim ES, Joo YE (2016) Long-Term Clinical Outcomes of Rectal Neuroendocrine Tumors According to the Pathologic Status After Initial Endoscopic Resection: A KASID Multicenter Study. Am J Gastroenterol 111:1276–1285

    Article  Google Scholar 

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Acknowledgements

The authors thank the medical staff members of the Department of Endoscopy, Mie University Hospital for their contribution to this work.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Mie University Hospital, Tsu, Japan

    Yasuhiko Hamada, Aiji Hattori, Yuhei Umeda, Hiroki Yukimoto, Reiko Yamada, Misaki Nakamura & Yoshiyuki Takei

  2. Department of Endoscopy, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Kyosuke Tanaka, Hiroshi Miura, Junya Tsuboi, Masaki Katsurahara & Noriyuki Horiki

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  1. Yasuhiko Hamada
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Contributions

YH and KT designed the study, collected, analyzed and interpreted the data, and drafted and reviewed the manuscript. AH, YU, HY, RY, MN, HM, JT, MK, NH, and YT collected the data and reviewed the manuscript. All authors have approved the final draft.

Corresponding author

Correspondence to Kyosuke Tanaka.

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Disclosures

Drs. Yasuhiko Hamada, Kyosuke Tanaka, Aiji Hattori, Yuhei Umeda, Hiroki Yukimoto, Reiko Yamada, Misaki Nakamura, Hiroshi Miura, Junya Tsuboi, Masaki Katsurahara, Noriyuki Horiki, and Yoshiyuki Takei have no conflict of interest or financial ties to disclose.

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Hamada, Y., Tanaka, K., Hattori, A. et al. Clinical utility of endoscopic submucosal dissection using the pocket-creation method with a HookKnife and preoperative evaluation by endoscopic ultrasonography for the treatment of rectal neuroendocrine tumors. Surg Endosc 36, 375–384 (2022). https://doi.org/10.1007/s00464-021-08292-6

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