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Feasibility of salvage endoscopic mucosal resection by using a cap for remnant rectal carcinoids after primary EMR.

 Soung Min Jeon  ;  Jin Ha Lee  ;  Sung Pil Hong  ;  Tae Il Kim  ;  Won Ho Kim  ;  Jae Hee Cheon 
 GASTROINTESTINAL ENDOSCOPY, Vol.73(5) : 1009-1014, 2011 
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Adult ; Aged ; Carcinoid Tumor/pathology ; Carcinoid Tumor/surgery* ; Dissection/methods* ; Endoscopy, Gastrointestinal/methods* ; Feasibility Studies ; Female ; Humans ; Intestinal Mucosa/pathology ; Intestinal Mucosa/surgery* ; Male ; Middle Aged ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery* ; Rectum/pathology* ; Reoperation/methods* ; Retrospective Studies
BACKGROUND: Secondary endoscopic treatment for remnant lesions of rectal carcinoid tumors after primary EMR or polypectomy is technically difficult because of fibrosis of residual tissues. EMR by using a cap (EMR-C), a method to resect the submucosal layer by suction by using a transparent cap, may be feasible as a salvage treatment. OBJECTIVE: To assess the feasibility of salvage EMR-C. DESIGN: Retrospective analysis. SETTING: Tertiary academic health care system. PATIENTS: Thirty-one patients who were referred for salvage treatment of a failed en bloc excision of rectal carcinoid tumors after primary EMR or polypectomy between January 2007 and December 2009. INTERVENTIONS: Salvage EMR-C for remnant carcinoid tumors in the rectum. MAIN OUTCOME MEASUREMENTS: Rate of complete resection, complications, length of procedure, and recurrence rate. RESULTS: The mean age of the patients was 52.0±11.8 years (range 30-78 years). The mean tumor size was 8.9±3.2 mm (range 5.0-13.0 mm). The mean procedure time was 9.1±3.7 minutes, and clear resection margins were pathologically confirmed in all 31 patients. The most common complication of salvage EMR-C was bleeding (7 patients, 22.6%), which was successfully treated by hemoclipping in all cases. The 1-year follow-up colonoscopy and CT results for all patients were negative for recurrence. LIMITATIONS: Retrospective design and limited cases at a single center. CONCLUSIONS: EMR-C is a feasible salvage therapeutic option for failed en bloc excision after primary endoscopic treatment of rectal carcinoid tumors.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Won Ho(김원호) ORCID logo https://orcid.org/0000-0002-5682-9972
Kim, Tae Il(김태일) ORCID logo https://orcid.org/0000-0003-4807-890X
Jeon, Soung Min(전승민)
Cheon, Jae Hee(천재희) ORCID logo https://orcid.org/0000-0002-2282-8904
Hong, Sung Pil(홍성필)
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