The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Endoscopic mucosal resection using anchored snare Tip-in versus precut technique for small rectal neuroendocrine tumors

  • Seung Wook Hong (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Dong-Hoon Yang (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoo Jin Lee (Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Dong Hoon Baek (Division of Gastroenterology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Jaeyoung Chun (Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Hyun Gun Kim (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Sung Joo Kim (Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seung-Mo Hong (Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Dae-Seong Myung (Department of Internal Medicine, Chonnam National Medical School)
  • Received : 2023.06.16
  • Accepted : 2023.09.01
  • Published : 2024.03.01
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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. Conclusions: 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.

Keywords

Acknowledgement

This study was performed by the intestinal tumor research interest group of Korean Association of the Study of Intestinal Diseases (KASID).

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