Guo XX, Zhang SH, Chen AJ, Chen YL, Chen FL. Efficacy and safety of pretraction-assisted endoscopic submucosal dissection for treating rectal neuroendocrine tumors. World J Gastrointest Endosc 2025; 17(9): 111734 [DOI: 10.4253/wjge.v17.i9.111734]
Corresponding Author of This Article
Feng-Lin Chen, MD, Department of Gastroenterology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, Fujian Province, China. drchenflxiehe@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xiao-Xiong Guo, Si-Han Zhang, Ai-Jin Chen, Yan-Ling Chen, Feng-Lin Chen, Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Author contributions: Guo XX performed the data analysis and drafted the manuscript; Zhang SH, Chen AJ, Chen YL contributed to data collection; Chen FL conceived and designed the study, and critically revised the manuscript; All authors have read and approved the final version to be published.
Supported by Fujian Province National Key Clinical Specialty Construction Project (Minwei Medical Policy Letter), No. [2023]1594.
Institutional review board statement: This study was approved by the Ethics Committee of Fujian Medical University Union Hospital (2025KY287).
Informed consent statement: Informed consent was waived for this retrospective study with the approval of the institutional ethical review committee, as the research involved no direct human interaction and utilized patient data obtained following written consent for clinical treatment. All identifiable patient information was removed during data processing to ensure full confidentiality and privacy protection.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng-Lin Chen, MD, Department of Gastroenterology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, Fujian Province, China. drchenflxiehe@163.com
Received: July 8, 2025 Revised: August 2, 2025 Accepted: August 20, 2025 Published online: September 16, 2025 Processing time: 66 Days and 11.3 Hours
Abstract
BACKGROUND
Conventional endoscopic submucosal dissection (c-ESD) is a widely used technique for rectal neuroendocrine tumors (NETs), but it poses certain challenges. To address these, we developed a pretraction-assisted endoscopic submucosal dissection (p-ESD) technique.
AIM
To compare the efficacy and safety of p-ESD and c-ESD for rectal NETs.
METHODS
This retrospective study included consecutive patients with rectal NETs measuring less than 15 mm who underwent either pESD or cESD at Fujian Medical University Union Hospital between January 2019 and December 2023. The study aimed to evaluate differences in dissection time, en bloc resection rate, R0 resection rate, and adverse event rates between the pESD and cESD groups.
RESULTS
In total, 103 patients were enrolled (49 in the p-ESD group and 54 in the c-ESD group). The p-ESD group exhibited a significantly shorter median dissection time (9.3 minutes vs 14.9 minutes; P < 0.001) and a higher R0 resection rate (100% vs 88.9%; P = 0.028), while en bloc resection rates were comparable. Rates of minor intraoperative bleeding (10.2% vs 25.9%; P = 0.040) and major intraoperative bleeding (4.1% vs 18.5%; P = 0.030) were lower in the p-ESD group. No muscularis propria injuries occurred in the p-ESD group vs 16.7% in the c-ESD group (P = 0.003). Other adverse events did not differ significantly.
CONCLUSION
p-ESD is safe and effective for treating rectal NETs. Compared with c-ESD, it is technically easier, requires less dissection time, achieves higher R0 resection rates, reduces intraoperative bleeding, and lowers the risk of muscularis propria injury.
Core Tip: This study compares pretraction-assisted endoscopic submucosal dissection (p-ESD) with conventional endoscopic submucosal dissection for rectal neuroendocrine tumors ≤ 15 mm. The results show that p-ESD significantly shortens dissection time, improves R0 resection rates, and reduces intraoperative bleeding and muscularis propria injury. These findings suggest that p-ESD is a safe, efficient, and technically advantageous technique for treating rectal neuroendocrine tumors.
