The Korean journal of internal medicine

  • 제39권2호
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  • Pages.238-247
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  • 2024
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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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)
  • 투고 : 2023.06.16
  • 심사 : 2023.09.01
  • 발행 : 2024.03.01
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초록

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.

키워드

과제정보

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

참고문헌

  1. Gordon JI, Hermiston ML. Differentiation and self-renewal in the mouse gastrointestinal epithelium. Curr Opin Cell Biol 1994;6:795-803. 
  2. Gastrointestinal Pathology Study Group of Korean Society of Pathologists; Cho MY, Kim JM, Sohn JH, et al. Current trends of the incidence and pathological diagnosis of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) in Korea 2000-2009: multicenter study. Cancer Res Treat 2012;44:157-165. 
  3. Tsai HJ, Wu CC, Tsai CR, Lin SF, Chen LT, Chang JS. The epidemiology of neuroendocrine tumors in Taiwan: a nation-wide cancer registry-based study. PLoS One 2013;8:e62487. 
  4. Fraenkel M, Kim M, Faggiano A, de Herder WW, Valk GD; Knowledge NETwork. Incidence of gastroenteropancreatic neuroendocrine tumours: a systematic review of the literature. Endocr Relat Cancer 2014;21:R153-R163. 
  5. Leoncini E, Boffetta P, Shafir M, Aleksovska K, Boccia S, Rindi G. Increased incidence trend of low-grade and high-grade neuroendocrine neoplasms. Endocrine 2017;58:368-379. 
  6. Xu Z, Wang L, Dai S, et al. Epidemiologic trends of and factors associated with overall survival for patients with gastroenteropancreatic neuroendocrine tumors in the United States. JAMA Netw Open 2021;4:e2124750. 
  7. de Mestier L, Brixi H, Gincul R, Ponchon T, Cadiot G. Updating the management of patients with rectal neuroendocrine tumors. Endoscopy 2013;45:1039-1046. 
  8. Son J, Park IJ, Yang DH, et al. Oncological outcomes according to the treatment modality based on the size of rectal neuroendocrine tumors: a single-center retrospective study. Surg Endosc 2022;36:2445-2455. 
  9. Zhou X, Xie H, Xie L, Li J, Cao W, Fu W. Endoscopic resection therapies for rectal neuroendocrine tumors: a systematic review and meta-analysis. J Gastroenterol Hepatol 2014;29:259-268. 
  10. Park HW, Byeon JS, Park YS, et al. Endoscopic submucosal dissection for treatment of rectal carcinoid tumors. Gastrointest Endosc 2010;72:143-149. 
  11. Ono A, Fujii T, Saito Y, et al. Endoscopic submucosal resection of rectal carcinoid tumors with a ligation device. Gastrointest Endosc 2003;57:583-587. 
  12. Moon JH, Kim JH, Park CH, et al. Endoscopic submucosal resection with double ligation technique for treatment of small rectal carcinoid tumors. Endoscopy 2006;38:511-514. 
  13. Kim JS, Kim YJ, Chung JW, et al. Usefulness of endoscopic resection using the band ligation method for rectal neuroendocrine tumors. Intest Res 2016;14:164-171. 
  14. Yang DH, Park Y, Park SH, et al. Cap-assisted EMR for rectal neuroendocrine tumors: comparisons with conventional EMR and endoscopic submucosal dissection (with videos). Gastrointest Endosc 2016;83:1015-1022; quiz 1023-.e6. 
  15. So H, Yoo SH, Han S, et al. Efficacy of precut endoscopic mucosal resection for treatment of rectal neuroendocrine tumors. Clin Endosc 2017;50:585-591. 
  16. Huang J, Lu ZS, Yang YS, et al. Endoscopic mucosal resection with circumferential incision for treatment of rectal carcinoid tumours. World J Surg Oncol 2014;12:23. 
  17. Cheung DY, Choi SK, Kim HK, et al. Circumferential submucosal incision prior to endoscopic mucosal resection provides comparable clinical outcomes to submucosal dissection for well-differentiated neuroendocrine tumors of the rectum. Surg Endosc 2015;29:1500-1505. 
  18. Lee HJ, Kim SB, Shin CM, et al. A comparison of endoscopic treatments in rectal carcinoid tumors. Surg Endosc 2016;30:3491-3498. 
  19. Lee HS, Moon HS, Kwon IS, et al. Comparison of conventional and modified endoscopic mucosal resection methods for the treatment of rectal neuroendocrine tumors. Surg Endosc 2021;35:6055-6065. 
  20. Hong JY, Kweon SS, Lee J, et al. Risk factors for procedure-related complications after endoscopic resection of colorectal laterally spreading tumors. Medicine (Baltimore) 2018;97:e12589. 
  21. Chien H, Imai K, Hotta K, et al. Tip-in EMR for R0 resection for a large flat colonic tumor. Gastrointest Endosc 2016;84:743. 
  22. Forte E, Jacques J, Rivory J, et al. Anchoring the snare tip using a small incision in the submucosa facilitates en bloc endoscopic mucosal resection for sporadic duodenal adenomas. Endoscopy 2017;49:1276-1277. 
  23. Jacques J, Legros R, Charissoux A, et al. Anchoring the snare tip by means of a small incision facilitates en bloc endoscopic mucosal resection and increases the specimen size. Endoscopy 2017;49(S 01):E39-E41. 
  24. Pioche M, Wallenhorst T, Lepetit H, et al. Endoscopic mucosal resection with anchoring of the snare tip: multicenter retrospective evaluation of effectiveness and safety. Endosc Int Open 2019;7:E1496-E1502. 
  25. Noh SM, Kim JY, Park JC, et al. Tip-in versus conventional endoscopic mucosal resection for flat colorectal neoplasia 10 mm or larger in size. Int J Colorectal Dis 2020;35:1283-1290. 
  26. Imai K, Hotta K, Ito S, et al. Tip-in Endoscopic Mucosal Resection for 15- to 25-mm Colorectal Adenomas: A Single-Center, Randomized Controlled Trial (STAR Trial). Am J Gastroenterol 2021;116:1398-1405. 
  27. Kim J, Kim J, Oh EH, et al. Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors. Sci Rep 2021;11:12918. 
  28. Zhang HP, Wu W, Yang S, Lin J. Endoscopic treatments for rectal neuroendocrine tumors smaller than 16 mm: a meta-analysis. Scand J Gastroenterol 2016;51:1345-1353. 
  29. Kim HH, Park SJ, Lee SH, et al. Efficacy of endoscopic submucosal resection with a ligation device for removing small rectal carcinoid tumor compared with endoscopic mucosal resection: analysis of 100 cases. Dig Endosc 2012;24:159-163. 
  30. Ebi M, Nakagawa S, Yamaguchi Y, et al. Endoscopic submucosal resection with an endoscopic variceal ligation device for the treatment of rectal neuroendocrine tumors. Int J Colorectal Dis 2018;33:1703-1708. 
  31. Kamigaichi Y, Yamashita K, Oka S, et al. Clinical outcomes of endoscopic resection for rectal neuroendocrine tumors: advantages of endoscopic submucosal resection with a ligation device compared to conventional EMR and ESD. DEN Open 2021;2:e35. 
  32. Park SS, Han KS, Kim B, et al. Comparison of underwater endoscopic mucosal resection and endoscopic submucosal dissection of rectal neuroendocrine tumors (with videos). Gastrointest Endosc 2020;91:1164-1171.e2. 
  33. Coutinho LMA, Lenz L, Kawaguti FS, et al. Underwater endoscopic mucosal resection for small rectal neuroendocrine tumors. Arq Gastroenterol 2021;58:210-213. 
  34. Shi H, Wang C, Wu J, et al. Underwater endoscopic mucosal resection for rectal neuroendocrine tumors (with videos): a single center retrospective study. BMC Gastroenterol 2022;22:276.