Abstract
Background
Endoscopic submucosal dissection (ESD) has an advantage over endoscopic mucosa resection (EMR) by enabling removal of gastrointestinal neoplasms en bloc. The ESD procedure is the treatment of choice for rectal carcinoids that have classic histologic architecture with minimal cellular pleomorphism and sparse mitoses, but it has not been applied for such tumors.
Methods
The ESD procedure was performed for patients with colorectal tumors that fulfilled the inclusion criteria specifying tumor with a diameter of 10 mm or less, no muscular layer invasion, and no metastases to the lymph nodes or distal organs. The ESD procedure was performed for patients with rectal carcinoids but no node or distal metastasis.
Results
This study enrolled 20 rectal carcinoid tumors from 20 consecutive patients. The mean tumor size was 7.6 mm (range, 3–16 mm). En bloc removal was achieved for all the tumors, and the complete resection (en bloc with tumor-free lateral/basal margins) rate was 90% (18/20). The two cases in which the margins were not evaluable due to burn effects still are free of recurrence and metastasis at this writing. Perforation was seen in one case, which was managed nonsurgically.
Conclusions
Precise histolopathogic assessment of the specimens resected en bloc by ESD may reduce tumor recurrence and metastasis after ESD. As the treatment of choice for small rectal carcinoids, ESD is associated with nominal risks of metastatic disease.
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References
Godwin JD II (1975) Carcinoid tumors: an analysis of 2,837 cases. Cancer 36:560–569
Soga J (2005) Early-stage carcinoids of the gastrointestinal tract: an analysis of 1,914 reported cases. Cancer 103:1587–1595
Modlin IM, Kidd M, Latich I et al (2005) Current status of gastrointestinal carcinoids. Gastroenterology 128:1717–1751
Kwaan MR, Goldberg JE, Bleday R (2008) Rectal carcinoid tumors: review of results after endoscopic and surgical therapy. Arch Surg 143:471–475
Gotoda T, Kondo H, Ono H et al (1999) A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc 50:560–563
Ono H, Kondo H, Gotoda T et al (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229
Fujishiro M, Yahagi N, Nakamura M et al (2006) Endoscopic submucosal dissection for rectal epithelial neoplasia. Endoscopy 38:493–497
Fujishiro M, Yahagi N, Kakushima N et al (2007) Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 5:678–683
Saito Y, Uraoka T, Matsuda T et al (2007) Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc 66:966–973
Tanaka S, Oka S, Chayama K (2008) Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol 43:641–651
Japanese Research Society for Cancer of the Colon and Rectum (1983) General rules for clinical and pathological studies on cancer of the colon, rectum, and anus: Part I. Clinical classification. Jpn J Surg 13:557–573
Isomoto H, Shikuwa S, Yamaguchi N, et al (2008) Endoscopic submucosal dissection for early gastric cancer: a large-scale follow-up study. Gut. Epub ahead of print November 10
Oda I, Gotoda T, Hamanaka H et al (2005) Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time, and complications from a large consecutive series. Dig Endosc 17:54–58
Iishi H, Tatsuta M, Yano H et al (1996) More effective endoscopic resection with a two-channel colonoscope for carcinoid tumors of the rectum. Dis Colon Rectum 39:1438–1439
Ono A, Fujii T, Saito Y et al (2003) Endoscopic submucosal resection of rectal carcinoid tumors with a ligation device. Gastrointest Endosc 57:583–587
Nagai T, Torishima R, Nakashima H et al (2004) Saline-assisted endoscopic resection of rectal carcinoids: cap aspiration method versus simple snare resection. Endoscopy 36:202–205
Kobayashi K, Katsumata T, Yoshizawa S et al (2005) Indications of endoscopic polypectomy for rectal carcinoid tumors and clinical usefulness of endoscopic ultrasonography. Dis Colon Rectum 48:285–291
Moon JH, Kim JH, Park CH et al (2006) Endoscopic submucosal resection with double ligation technique for treatment of small rectal carcinoid tumors. Endoscopy 38:511–514
Jetmore AB, Ray JE, Gathright JB Jr et al (1992) Rectal carcinoids: the most frequent carcinoid tumor. Dis Colon Rectum 35:717–725
Mashimo Y, Matsuda T, Uraoka T et al (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
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N. Yamaguchi, H. Isomoto, and S. Shikuwa equally contributed to this study.
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Yamaguchi, N., Isomoto, H., Nishiyama, H. et al. Endoscopic submucosal dissection for rectal carcinoid tumors. Surg Endosc 24, 504–508 (2010). https://doi.org/10.1007/s00464-009-0606-0
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DOI: https://doi.org/10.1007/s00464-009-0606-0