Comparison of endoscopic therapies for rectal carcinoid tumors: Endoscopic mucosal resection with circumferential incision versus endoscopic submucosal dissection

Background and objective: Although various endoscopic resection techniques have been established for rectal carcinoid tumors, there remains controversy regarding the best endoscopic treatment modality for these tumors. This study aimed to evaluate and compare the therapeutic efficacy and safety of EMR with circumferential incision (EMR-CI) and endoscopic submucosal dissection (ESD) for endoscopic resection of rectal carcinoid tumors. Methods: From March 2012 to June 2016, 66 rectal carcinoid tumors in 66 patients were resected by using EMR-CI (n=30) or ESD (n=36). The rates of both en bloc resection and complete resection, procedure time, procedure-related complications, and local or metastatic recurrence were analyzed retrospectively. Results: The en bloc resection rate was 96.7% (29/30) and 100% (36/36) for EMR-CI and ESD groups, respectively, and the difference was not statistically significant (P=0.455). The complete resection rate of the ESD group was 97.2% (35/36) and significantly higher than 76.7% (23/30) of the EMR-CI group (P=0.030). The mean procedure time of the ESD group was 20.44 +/- 6.64 minutes, which was significantly longer than that of the EMR-CI group at 8.47 +/- 3.40 minutes (P<0.001). The complication rates for ESD and EMR-CI did not differ significantly (0% for EMR-CI vs. 2.8% for ESD, P=1.000). No local or metastatic recurrence was found in either group during the follow-up period. Conclusion: This study suggested that ESD may be a safe, effective, and feasible endoscopic technique for removing rectal carcinoid tumors. ESD showed a similar safety profile and superior efficacy to EMR-CI. (C) 2017 Elsevier Masson SAS. All rights reserved.