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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Endoscopic submucosal dissection and hybrid endoscopic submucosal dissection for stage 1 rectal neuroendocrine tumors
Xue-Yan Qiao, Xiu-Jiao Shen, Yan-Hua Lv, Ruo-Bing Chen, Jun Weng, Guo-Liang Xu, Ge Wen, Kun-Hao Bai
Xue-Yan Qiao, Ge Wen, Department of Medical Imaging, Nanfang Hospital, Southern Medical University Nanfang Hospital, Guangzhou 510515, Guangdong Province, China
Xue-Yan Qiao, Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong Province, China
Xiu-Jiao Shen, Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Yan-Hua Lv, Ruo-Bing Chen, Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Jun Weng, Guo-Liang Xu, Kun-Hao Bai, Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Kun-Hao Bai, Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
Co-first authors: Xue-Yan Qiao and Xiu-Jiao Shen.
Co-corresponding authors: Ge Wen and Kun-Hao Bai.
Author contributions: Qiao XY and Shen XJ prepared the manuscript draft, they contributed equally to this article, they are the co-first authors of this manuscript; Qiao XY, Shen XJ, Lv YH, Chen RB, and Weng J collected and analyzed data; Xu GL, Wen G, and Bai KH provided research support and revised the manuscript; Wen G and Bai KH designed the research, they contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 82403973.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Sun Yat-sen University Cancer Center, approval No. SL-B2023-722-01.
Informed consent statement: All participants were already asked to give signed informed consent before the operation. So, when this retrospective study was checked by the ethics committee, another informed consent was exempt.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
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: Kun-Hao Bai, MD, Department of Endoscopy, Sun Yat-sen University Cancer Center, No. 651 Dongfengdong Street, Yuexiu District, Guangzhou 510060, Guang
dong Province, China.
baikh@sysucc.org.cn
Received: August 8, 2025
Revised: September 14, 2025
Accepted: November 13, 2025
Published online: December 24, 2025
Processing time: 137 Days and 15.4 Hours
BACKGROUND
The technical complexity and potential for complications associated with endoscopic submucosal dissection (ESD) pose limitations on the widespread use of this procedure for stage 1 rectal neuroendocrine tumors (NETs), despite its high success rate in achieving complete resection (R0).
AIM
To examine the results of ESD and hybrid ESD, a simpler adaptation of the ESD technique, for stage 1 rectal NETs.
METHODS
Seventy-nine patients with 84 lesions of clinical stage 1 rectal NETs who received treatment at Sun Yat-sen University Cancer Center from January 2010 to June 2021 were reviewed retrospectively.
RESULTS
Sixty-one lesions in 58 patients were treated with ESD, while 23 in 21 patients were treated with hybrid ESD. The 84 rectal NETs had a median diameter of 8 (5) mm (range, 3-20 mm), with the median lesion size 8 (5) mm for ESD and 8 (4) mm for hybrid ESD (P = 0.359). For ESD, the median duration of procedure was 46.00 (14.00) minutes, while for hybrid ESD, it was 32.00 (15.00) minutes (P < 0.001). Both the ESD and hybrid ESD groups had identical rates of en bloc resection (100.00% vs 100.00%, P = 1.000), R0 resection (86.89% vs 86.96%, P = 1.000), perforation (1.64% vs 0.00%, P = 1.000), and delayed bleeding (1.64% vs 4.35%, P = 0.475). After a median of 27.50 (30.00) months of observation, neither group had recurrence.
CONCLUSION
For endoscopic excision of stage 1 rectal NETs, both ESD and hybrid ESD were well tolerated and produced positive results, with similar efficacy and safety.
Core Tip: Despite a high complete resection (R0) rate, its technical difficulty and risk of complications limit the widespread use of endoscopic submucosal dissection (ESD) for stage 1 rectal neuroendocrine tumors (NETs). One simplified modification to ESD is hybrid ESD (ESD with snaring). This research analyzed 84 lesions who were diagnosed with rectal NETs and treated with ESD or hybrid ESD. We found that both ESD and hybrid ESD were safe and effective for endoscopic resection of stage 1 rectal NETs, and hybrid ESD can be a good alternative to ESD for R0 resection of stage 1 rectal NETs.
