Analysis of different endoscopic methods for resection of rectal neuroendocrine tumors: A 10‐year experience at a secondary care hospital

Rectal neuroendocrine tumors (NETs) account for one‐third of all digestive NETs and are often incidentally found during colonoscopy. They also carry the risk of metastasis. Given their subepithelial growth, complete removal, R0 resection, is a challenge for endoscopists. Inadequate endoscopic management would lead to incomplete removal and additional complications for surveillance. The aim of this study is to compare R0 resection rates among all endoscopic methods. The database of our pathology department was reviewed from January 2005 to July 2015. Diagnoses of carcinoid and NETs located at rectum were enrolled. NETs removed by endoscopy were further selected for analysis. R0 resection was defined as being free of tumor at lateral and vertical margins on pathological examination. Three methods of endoscopic management were performed for our patients; these were snare polypectomy, endoscopic submucosal resection‐ligation assisted (ESMR‐L), and endoscopic submucosal dissection (ESD). In all, 48 rectal NETs were diagnosed. Thirty‐six rectal NETs were removed by endoscopy. Pathology validated hepatic metastasis was found in a patient with18 mm tumor size and G2 mitosis. The R0 resection rates for snare polypectomy, ESMR‐L, and ESD were 33.3% (6/18), 90.9% (10/11), and 100% (7/7) respectively ( P  = 0.001). Procedure time for the ESMR‐L group (5.36 min) was shorter than the ESD group (38.86 min) ( P  < 0.001). Percentage of patients receiving endoscopic ultrasonography before endoscopic management also revealed significant differences among the three groups (3/18, 16.7%; 6/11, 54.5%; 7/7, 100%; P  = 0.001). ESD offered the highest R0 resection rate, followed by ESMR‐L and snare polypectomy. However, ESMR‐L has shorter procedure time.