Endoscopic mucosal resection using anchored snare Tip-in versus precut technique for small rectal neuroendocrine tumors

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Authors: Seung Wook Hong ; Dong-Hoon Yang ; Yoo Jin Lee ; Dong Hoon Baek ; Jaeyoung Chun ; Hyun Gun Kim ; Sung Joo Kim ; Seung-Mo Hong ; Dae-Seong Myung

MeSH: Endoscopic Mucosal Resection* / adverse effects ; Humans ; Intestinal Mucosa / diagnostic imaging ; Intestinal Mucosa / pathology ; Intestinal Mucosa / surgery ; Neuroendocrine Tumors* / diagnostic imaging ; Neuroendocrine Tumors* / pathology ; Neuroendocrine Tumors* / surgery ; Prospective Studies ; Rectal Neoplasms* / pathology ; Rectal Neoplasms* / surgery ; Retrospective Studies ; Treatment Outcome

Keywords: Endoscopic mucosal resection ; Multicenter study ; Neuroendocrine tumors ; Randomized controlled trial

Abstract: Background/aims: Small rectal neuroendocrine tumors (NETs) can be treated with modified endoscopic mucosal resection (EMR). However, an optimal EMR method remains to be established. We aimed to assess the non-inferiority of Tip-in EMR versus precut EMR (EMR-P) for treating rectal NETs.

Methods: This prospective, multicenter, randomized controlled trial enrolled patients with rectal NETs of < 10 mm in diameter. The patients were randomly assigned to EMR-P and Tip-in EMR groups in a 1:1 ratio. Primary outcome was margin-negative (R0) resection rate between the two methods, with a noninferiority margin of 10%.

Results: Seventy-five NETs in 73 patients, including 64 eligible lesions (32 lesions in each, EMR-P and Tip-in EMR groups), were evaluated. In a modified intention-to-treat analysis, R0 resection rates of the EMR-P and Tip-in EMR groups were 96.9% and 90.6%, respectively, which did not demonstrate non-inferiority (risk difference, -6.3 [95% confidence interval: -18.0 to 5.5]). Resection time in the EMR-P group was longer than that in the Tip-in EMR group (p < 0.001). One case of intraprocedural bleeding was reported in each group.

Conclusion: We did not demonstrate the non-inferiority of Tip-in EMR compared to EMR-P for treating small rectal NETs. However, the R0 resection rates for both techniques were high enough for clinical application.