Comparison of endoscopic submucosal resection with ligation and endoscopic submucosal dissection for small rectal neuroendocrine tumors: A multicenter retrospective study
Kenshi Matsuno,
Hideaki Miyamoto,
Hideki Kitada,
Shinichi Yoshimatsu,
Fumio Tamura,
Kouichi Sakurai,
Kotaro Fukubayashi,
Takashi Shono,
Hiroko Setoyama,
Taichi Matsuyama,
Shinichiro Suko,
Rei Narita,
Munenori Honda,
Masakuni Tateyama,
Hideaki Naoe,
Jun Morinaga,
Yasuhito Tanaka,
Ryosuke Gushima
Affiliations
Kenshi Matsuno
Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
Hideaki Miyamoto
Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
Hideki Kitada
Department of Gastroenterology Japanese Red Cross Kumamoto Hospital Kumamoto Japan
Shinichi Yoshimatsu
Department of Gastroenterology Kumamoto General Hospital Community Health Care Organization Kumamoto Japan
Fumio Tamura
Department of Gastroenterology Kumamoto Regional Medical Center Kumamoto Japan
Kouichi Sakurai
Hattori Clinic Kumamoto Japan
Kotaro Fukubayashi
Department of Gastroenterology Tamana Central Hospital Kumamoto Japan
Takashi Shono
Department of Gastroenterology Kumamoto Chuo Hospital Kumamoto Japan
Hiroko Setoyama
Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
Taichi Matsuyama
Department of Gastroenterology National Hospital Organization Kumamoto Medical Center Kumamoto Japan
Shinichiro Suko
Department of Gastroenterology Saiseikai Kumamoto Hospital Kumamoto Japan
Rei Narita
Department of Gastroenterology Minamata City Hospital and Medical Center Kumamoto Japan
Munenori Honda
Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
Masakuni Tateyama
Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
Hideaki Naoe
Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
Jun Morinaga
Department of Clinical Investigation (Biostatistics) Kumamoto University Hospital Kumamoto Japan
Yasuhito Tanaka
Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
Ryosuke Gushima
Department of Gastroenterology and Hepatology Faculty of Life Sciences Kumamoto University Kumamoto Japan
Abstract Objectives Endoscopic submucosal resection with band ligation (ESMR‐L) and endoscopic submucosal dissection (ESD) are both standard endoscopic resection methods for rectal neuroendocrine tumors (NETs) <10 mm in size. However, there is no definitive consensus on which is better. Here, we compared the efficacy of ESMR‐L and ESD for small rectal NETs. Methods This was a multicenter retrospective cohort study including 205 patients with rectal NETs who underwent ESMR‐L or ESD. Treatment outcomes were compared by univariate analysis, multivariate analysis, and inverse probability treatment weighting (IPTW) using propensity scores. Subgroup analysis evaluated the impact of the endoscopist's experience on the technical outcome. Results Eighty‐nine patients were treated by ESMR‐L and 116 by ESD. The R0 resection rate was not significantly different between the two (90% vs. 92%, p = 0.73). The procedure time of ESMR‐L was significantly shorter than for ESD (17 min vs. 52 min, p < 0.01) and the hospitalization period was also significantly shorter (3 days vs. 5 days, p < 0.01). These results were confirmed by multivariate analysis and also after IPTW adjustment. The procedure time of ESD was significantly prolonged by a less‐experienced endoscopist (49 min vs. 70 min, p = 0.02), but that of ESMR‐L was not affected (17 min vs. 17 min, p = 0.27). Conclusions For small rectal NETs, both ESMR‐L and ESD showed similar high complete resection rates. However, considering the shorter procedure time and shorter hospitalization period, ESMR‐L is the more efficient treatment method, especially for less‐experienced endoscopists.
