Ligation-assisted endoscopic mucosal resection has high complete resection rate in rectal carcinoid tumor

Aim We aimed to compare the outcomes of different therapeutic modalities in rectal carcinoid tumors. Method We retrospectively collected 145 patients with rectal carcinoid tumors which were pathologically diagnosed from 2005/01/01 to 2016/12/31. We compared tumor size, complete resection rate and recurrent rate between different therapeutic modalities. Then, prospectively compared the treatment outcomes of 28 patients treated with ligation assisted endoscopic mucosal resection (LEMR) and 25 patients treated with endoscopic mucosal resection with cap (EMRC). Result The mean size of tumors was 6.5 mm (1–25 mm), and the mean follow-up duration was 26 months (6–118 months). The therapeutic modalities included ligation-assisted endoscopic mucosal resection (LEMR) (25 tumors, 17%), endoscopic mucosal resection (EMR) (31 tumors, 21%), snare polypectomy (30 tumors, 21%), biopsy forceps removal (46 tumors, 32%) and surgical resection (13 tumors, 11%), including 6 tumors treated with transanal endoscopic microsurgery (TEM) method. In view of pathologically complete resection rate, LEMR was highest (100%), followed by surgical resection (85%). However, EMR only had 42% pathologically complete resection rate. Besides, LEMR and surgical resection had no local recurrence and significantly higher clinically complete resection rate, compared to other treatments. For the further prospective study, complete resection was noted in 28 (100%) patients in LEMR group and 13 (52%) patients in EMRC group. Conclusion In the treatment of rectal carcinoid tumors, LEMR is safe and effective compared with traditional endoscopic treatments.

Ligation-Assisted Endoscopic Mucosal Resection Has High Complete Resection Rate in Rectal Carcinoid Tumor

Aim: We aimed to compare the outcomes of different therapeutic modalities in rectal carcinoid tumors. Method: We retrospectively collected 145 patients with rectal carcinoid tumors which were pathologically diagnosed from 2005/01/01 to 2016/12/31. We compared tumor size, complete resection rate and recurrent rate between different therapeutic modalities. Then, prospectively compared the treatment outcmes of 28 patients treated with ligation assisted endoscopic mucosal resection (LEMR) and 25 patients treated with endoscopic mucosal resection with cap (EMRC). Result: The mean size of tumors was 6.5mm (1-25mm), and the mean follow-up duration was 26 months (6-118 months). The therapeutic modalities included ligation-assisted endoscopic mucosal resection (LEMR) (25 tumors, 17%), endoscopic mucosal resection (EMR) (31 tumors, 21%), snare polypectomy (30 tumors, 21%), biopsy forceps removal (46 tumors, 32%) and surgical resection (13 tumors, 11%), including 6 tumors treated with transanal endoscopic microsurgery (TEM) method. In view of pathologically complete resection rate, LEMR was highest (100%), followed by surgical resection (85%). However, EMR only had 42% pathologically complete resection rate. Besides, LEMR and surgical resection had no local recurrence and significantly higher clinically complete resection rate, compared to other treatments. For the further prospective study, complete resection were noted in 28 (100%) patients in LEMR group and 13 (52%) patients in EMRC group. Conclusion: In the treatment of rectal carcinoid tumors, LEMR is safe and effective compared with traditional endoscopic treatments.

Multivariable analysis for complete resection rate of 10-20 mm non-metastatic rectal neuroendocrine tumors: a retrospective clinical study

Background: This retrospective study aimed to identify key factors affecting the rate of complete resection for non-metastatic rectal neuroendocrine tumors (NETs) using both transanal local excision (TLE) and endoscopic submucosal dissection (ESD). Methods: Records in the past 10 years were retrieved, for a total of 95 patients diagnosed with non-metastatic rectal NETs sized between 10-20 mm. Treatment outcomes were first compared between TLE and ESD to identify significantly associated factors. Monofactor analysis was then performed between complete and local resections to identify risk factors, which were then subjected to a multivariable analysis to identify independent risk factors. Results: Treatment outcomes between TLE and ESD were significantly associated with depth of invasion (P=0.039) and complete/local resection (P=0.048). By monofactor analysis between complete and local resections, depth of invasion, tumor size, tumor stage and endoscopic manifestation were identified to be risk factors (P=0.014, 0.003, 0.002 and 0.028, respectively). In subsequent multivariable analysis, depth of invasion and tumor size were independent risk factors, with odds ratio of 18.838 and 37.223, and 95% confidence interval of 1.242-285.800 and 2.839-488.078, respectively. Conclusion: Depth of invasion and tumor size were independent risk factors that significantly affect the complete resection rate of 10-20 mm non-metastatic rectal NETs.

Analysis of factors associated with local recurrence after endoscopic resection of gastric epithelial dysplasia

Background: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely used techniques for the treatment of gastric epithelial dysplasia. Previous studies have compared the clinical outcome of endoscopic resection for early gastric cancer, but few studies have focused on gastric dysplasia alone. This study aimed to evaluate the long-term prognosis following endoscopic procedures for gastric epithelial dysplasia, investigate differences in local recurrence rates according to the treatment modality, and identify risk factors associated with local recurrence. Methods: In this retrospective study, local recurrence rates and risk factors associated with local recurrence were compared between 599 patients who underwent EMR and 306 who underwent ESD for gastric epithelial dysplasia from January 2011 to December 2015.Results: The en bloc resection rate (32.2% vs. 100%, p<0.001) and complete resection rate (94.8% vs. 99.0%, p=0.003) were significantly lower in the EMR group than in the ESD group. The local recurrence rate was significantly lower in the ESD group (1.3%) than in the EMR group (4.2%; p=0.026). There was a significantly increased risk of local recurrence, regardless of lesion location or histologic grade, in patients with lesions >2 cm (p=0.002) or red in color (p=0.03). The ESD group had a significantly lower local recurrence rate, with a higher complete resection rate, than that in the EMR group (p<0.05). In the case of recurrence after endoscopic resection, most of the recurred lesions were removed through additional endoscopic procedures; there was no difference between the two groups ( p=0.153).Conclusions: The complete resection rate was significantly higher, and the local recurrence rate was significantly lower, in patients with gastric epithelial dysplasia treated with ESD. Therefore, ESD should be considered the preferred treatment in patients with lesions >2 cm or showing redness due to an increased risk of local recurrence and EMR may be possible for low-grade dysplasia that is less than 2 cm without surface changes such as redness, depression and nodularity.

Analysis of factors associated with local recurrence after endoscopic resectionof gastric epithelial dysplasia: A retrospective study

Background: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely used techniques for the treatment of gastric epithelial dysplasia. Previous studies have compared the clinical outcome of endoscopic resection for early gastric cancer, but few studies have focused on gastric dysplasia alone. This study aimed to evaluate the long-term prognosis following endoscopic procedures for gastric epithelial dysplasia, investigate differences in local recurrence rates according to the treatment modality, and identify risk factors associated with local recurrence. Methods: In this retrospective study, local recurrence rates and risk factors associated with local recurrence were compared between 599 patients who underwent EMR and 306 who underwent ESD for gastric epithelial dysplasia from January 2011 to December 2015.Results: The en bloc resection rate (32.2% vs. 100%, p<0.001) and complete resection rate (94.8% vs. 99.0%, p=0.003) were significantly lower in the EMR group than in the ESD group. The local recurrence rate was significantly lower in the ESD group (1.3%) than in the EMR group (4.2%; p=0.026). There was a significantly increased risk of local recurrence, regardless of lesion location or histologic grade, in patients with lesions >2 cm (p=0.002) or red in color (p=0.03). The ESD group had a significantly lower local recurrence rate, with a higher complete resection rate, than that in the EMR group (p<0.05).Conclusions: The complete resection rate was significantly higher, and the local recurrence rate was significantly lower, in patients with gastric epithelial dysplasia treated with ESD. Therefore, ESD should be considered the preferred treatment in patients with lesions >2 cm or showing redness due to an increased risk of local recurrence.

Comparison of different endoscopic resection techniques for submucosal tumors originating from muscularis propria at the esophagogastric junction

Background To compare the outcomes of submucosal tunneling endoscopic resection (STER) and submucosal excavation (ESE) for the treatment of submucosal tumors (SMTs) arising from the muscularis propria (MP) at the esophagogastric junction (EGJ). Methods A retrospective analysis of patients with SMTs at EGJ who underwent STER and ESE from October 2011 to October 2017 was performed. The outcomes evaluated were operation time, complete resection rate, adverse events, and tumor recurrence. Results Ninety patients were included in this study. Complete resection rates in the STER group were higher than those of the ESE group (100 vs. 92%, p < 0.05). For tumors ≤15 mm, both techniques achieved 100% complete resection rate; but for tumors > 15 mm, complete resection rate was higher in the STER group than the ESE group (100% vs. 77.8%, p < 0.05). Subgroup analyses revealed that the operation time of STER for in cardiac-gastric group was longer than that for ESE (145.14 ± 42.43 min vs. 70.32 ± 39.84 min, p < 0.05). The air leakage symptoms were more frequent in STER group (90.9% vs. 50.0%, p < 0.05). No tumor recurrence occurred in both the STER and ESE groups. Conclusions For SMTs ≤15 mm, both STER and ESE have similar satisfactory therapeutic outcomes. However, in the cardiac-gastric subgroup, STER had a longer operative time compared to the ESE procedure. For SMTs > 15 mm, STER is the preferred choice due to its higher complete resection rate.

Analysis of factors associated with local recurrence after endoscopic resection of gastric epithelial dysplasia

Background : Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely used techniques for the treatment of gastric epithelial dysplasia. Previous studies have compared the clinical outcome of endoscopic resection for early gastric cancer, but few studies have focused on gastric dysplasia alone. This study aimed to evaluate the long-term prognosis following endoscopic procedures for gastric epithelial dysplasia, investigate differences in local recurrence rates according to the treatment modality, and identify risk factors associated with local recurrence. Methods : In this retrospective study, local recurrence rates and risk factors associated with local recurrence were compared between 599 patients who underwent EMR and 306 who underwent ESD for gastric epithelial dysplasia from January 2011 to December 2015. Results : The en bloc resection rate (32.2% vs. 100%, p<0.001) and complete resection rate (94.8% vs. 99.0%, p=0.003) were significantly lower in the EMR group than in the ESD group. The local recurrence rate was significantly lower in the ESD group (1.3%) than in the EMR group (4.2%; p=0.026). There was a significantly increased risk of local recurrence, regardless of lesion location or histologic grade, in patients with lesions >2 cm (p=0.002) or red in color (p=0.03). The ESD group had a significantly lower local recurrence rate, with a higher complete resection rate, than that in the EMR group (p<0.05). Conclusions : The complete resection rate was significantly higher, and the local recurrence rate was significantly lower, in patients with gastric epithelial dysplasia treated with ESD. Therefore, ESD should be considered the preferred treatment in patients with lesions >2 cm or showing redness due to an increased risk of local recurrence.