Advantage of endoscopic mucosal resection with a cap for rectal neuroendocrine tumors

AIM: To compare the outcomes of endoscopic mucosal resection with a cap (EMR-C) with those of endoscopic submucosal dissection (ESD) for the resection of rectal neuroendocrine tumors. METHODS: One hundred and sixteen lesions in 114 patients with rectal neuroendocrine tumor (NET) resected with EMR-C or ESD were included in the study. This study was performed at Pusan National University Yangsan Hospital between July 2009 and August 2014. We analyzed endoscopic complete resection rate, pathologic complete resection rate, procedure time, and adverse events in the EMR-C (n = 65) and ESD (n = 51) groups. We also performed a subgroup analysis by tumor size. RESULTS: Mean tumor size was 4.62 +/- 1.66 mm in the EMR-C group and 7.73 +/- 3.14 mm in the ESD group (P < 0.001). Endoscopic complete resection rate was 100% in both groups. Histologic complete resection rate was significantly greater in the EMR-C group (92.3%) than in the ESD group (78.4%) (P = 0.042). Mean procedure time was significantly longer in the ESD group (14.43 +/- 7.26 min) than in the EMR-C group (3.83 +/- 1.17 min) (P < 0.001). Rates of histologic complete resection without complication were similar for tumor diameter <= 5 mm (EMR-C, 96%; ESD, 100%, P = 0.472) as well as in cases of 5 mm < tumor diameter <= 10 mm (EMR-C, 80%; ESD, 71.0%, P = 0.524). CONCLUSION: EMR-C may be simple, faster, and more effective than ESD in removing rectal NETs and may be preferable for resection of small rectal NETs.