Randomized Controlled Trial
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2023; 15(3): 440-449
Published online Mar 27, 2023. doi: 10.4240/wjgs.v15.i3.440
Endoscopic mucosal resection with double band ligation versus endoscopic submucosal dissection for small rectal neuroendocrine tumors
Jia-Lan Huang, Ri-Yun Gan, Ze-Han Chen, Ruo-Yu Gao, De-Feng Li, Li-Sheng Wang, Jun Yao
Jia-Lan Huang, Ri-Yun Gan, Ze-Han Chen, Department of Gastroenterology, The Second Clinical Medical College, Jinan University, Shenzhen 518020, Guangdong Province, China
Ruo-Yu Gao, Department of Gastroenterology, Shenzhen Luohu People's Hospital, Shenzhen 518020, Guangdong Province, China
De-Feng Li, Li-Sheng Wang, Jun Yao, Department of Gastroenterology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong Province, China
Author contributions: Yao J was responsible for design of the study and reviewed the manuscript; Huang JL drafted the manuscript; Huang JL, Gan RY, Chen ZH and Gao RY contributed to data acquisition, analysis, and interpretation; Yao J, Li DF and Wang LS were responsible for revising manuscript; All authors have read and approved the final manuscript.
Supported by Technical Research and Development Project of Shenzhen, No. JCYJ20210324113215040.
Institutional review board statement: The study was reviewed and approved by the ethics committee of Shenzhen People's Hospital (Approval No. LL-KY-2022152-01).
Clinical trial registration statement: This study is registered at Chinese Clinical Trial Registry. The registration identification number is ChiCTR2200063871.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at yao.jun@szhospital.com. Participants gave informed consent for data sharing.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
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: Jun Yao, MD, PhD, Associate Chief Physician, Associate Professor, Department of Gastroenterology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), 1017 East Gate Road, Shenzhen 518020, Guangdong Province, China. yao.jun@szhospital.com
Received: December 6, 2022
Peer-review started: December 6, 2022
First decision: December 27, 2022
Revised: January 9, 2023
Accepted: February 27, 2023
Article in press: February 27, 2023
Published online: March 27, 2023
Processing time: 110 Days and 22.7 Hours
Abstract
BACKGROUND

Endoscopic resection remains an effective method for the treatment of small rectal neuroendocrine tumors (NETs) (≤ 10 mm). Moreover, endoscopic mucosal resection (EMR) with double band ligation (EMR-dB), a simplified modification of EMR with band ligation, is an alternative strategy to remove small rectal NETs.

AIM

To evaluate the feasibility and safety of EMR-dB for the treatment of small rectal NETs (≤ 10 mm).

METHODS

A total of 50 patients with small rectal NETs, without regional lymph node enlargement or distant metastasis confirmed by endoscopic ultrasound, computerized tomography scan, or magnetic resonance imaging, were enrolled in the study from March 2021 to June 2022. These patients were randomly assigned into the EMR-dB (n = 25) group or endoscopic submucosal dissection (ESD) group (n = 25). The characteristics of the patients and tumors, procedure time, devices cost, complete resection rate, complications, and recurrence outcomes were analyzed.

RESULTS

There were 25 patients (13 males, 12 females; age range 28-68 years old) in the EMR-dB group, and the ESD group contained 25 patients (15 males, 10 females; age range 25-70 years old). Both groups had similar lesion sizes (EMR-dB 4.53 ± 1.02 mm, ESD 5.140 ± 1.74 mm; P = 0.141) and resected lesion sizes(1.32 ± 0.52 cm vs 1.58 ± 0.84 cm; P = 0.269). Furthermore, the histological complete resection and en bloc resection rates were achieved in all patients (100% for each). In addition, there was no significant difference in the complication rate between the two groups. However, the procedure time was significantly shorter and the devices cost was significantly lower in the EMR-dB group. Besides, there was no recurrence in both groups during the follow-up period.

CONCLUSION

The procedure time of EMR-dB was shorter compared with ESD, and both approaches showed a similar curative effect. Taken together, EMR-dB was a feasible and safe option for the treatment of small rectal NETs.

Keywords: Small rectal neuroendocrine tumor; Endoscopic submucosal dissection; Endoscopic mucosal resection; Ligation; complete resection rate; Complication

Core Tip: Endoscopic mucosal resection (EMR) with double band ligation (EMR-dB), a simplified modification of EMR with band ligation, is an alternative strategy to remove small rectal neuroendocrine tumors (NETs). Our study first evaluates the feasibility and safety of EMR-dB and endoscopic submucosal dissection (ESD) for the treatment of small rectal NETs (≤ 10 mm). We discovered that the EMR-dB technique took less time than ESD, and displayed a similar curative effect to ESD. If no lymph nodes and distant metastases are revealed by either endoscopic ultrasound or computerized tomography, EMR-dB is a feasible and safe option for the treatment of small rectal NETs.