Efficacy and Safety of Endoscopic Resection Therapies for Rectal Carcinoid Tumors: A Meta-Analysis

PURPOSE: Several endoscopic resection therapies have been applied for the treatment of rectal carcinoid tumors. However, there is currently no consensus regarding the optimal strategy. We performed a meta-analysis to compare the efficacy and safety of endoscopic mucosal resection (EMR) or modified EMR (m-EMR) versus endoscopic submucosal dissection (ESD) for the treatment of rectal carcinoid tumors. MATERIALS AND METHODS: PubMed, Web of Science, Medline, Embase and CNKI were searched up to the end of January 2014 in order to identify all studies on the effects of EMR (or m-EMR) and ESD on rectal carcinoid tumors. RESULTS: A total of fourteen studies involving 782 patients were included. The pooled data suggested a significantly higher rate of pathological complete resection among patients treated with ESD or m-EMR than those treated with EMR [odds ratio (OR)=0.42, 95% confidence interval (CI): 0.25-0.71; OR=0.10, 95% CI: 0.03-0.33, respectively], while there was no significant difference between the m-EMR group and ESD group (OR=1.19, 95% CI: 0.49-2.86); The procedure time of ESD was longer than EMR or m-EMR groups [mean differences (MD)=-11.29, 95% CI: -14.19 - -8.38, MD= -10.90, 95% CI: -18.69 - -3.11, respectively], but it was insignificance between the EMR and m-EMR groups. No significant differences were detected among the treatment groups with regard to complications or recurrence. CONCLUSION: The results of this meta-analysis suggest that treatment of rectal carcinoid tumors with ESD or m-EMR is superior to EMR, and the efficacy of m-EMR is equivalence to ESD treatment. However, more well-designed studies are needed to confirm these findings.

The Effect of Preceding Biopsy on Complete Endoscopic Resection in Rectal Carcinoid Tumor

Biopsy of rectal carcinoid tumor is commonly taken before endoscopic resection. However the preceding biopsy can inhibit complete resection by causing blurred tumor border and fibrosis of the tissue. The objective of the study was to investigate the effect of preceding biopsy on complete endoscopic resection in rectal carcinoid tumor. It was also determined if rectal carcinoid tumors can be macroscopically distinguished by endoscopy. We reviewed retrospectively the records of patients with rectal carcinoid tumor who had undergone an endoscopic treatment at our hospital, during a 7-yr period. The resection margin was clear in 57 of 98 cases. The preceding biopsy was taken in 57 cases and the biopsy was significantly associated with the risk of incomplete tumor resection (OR, 3.696; 95% CI, 1.528-8.938, P = 0.004). In 95.9% of the cases, it was possible to suspect a carcinoid tumor by macroscopic appearance during initial endoscopy. The preceding biopsy may disturb complete resection of rectal carcinoid tumor. In most cases, the carcinoid tumor could be suspected by macroscopic appearance. Therefore the preceding biopsy is not essential, and it may be avoided for the complete resection.

Endoscopic Resection for Rectal Carcinoid Tumors: Comparision of Polypectomy and Endoscopic Submucosal Resection with Band Ligation

BACKGROUND/AIMS: Rectal carcinoid tumors, at diagnosis, are as small as 10 mm or less in about 80% of patients. These tumors are generally removed by endoscopic resection. The aim of this study was to compare treatment efficacy and safety between endoscopic submucosal resection with band ligation (ESMR-L) and conventional polypectomy. METHODS: Between January 2005 and September 2010, a total of 88 patients, who visited at Busan Paik Hospital and Kosin University Gospel Hospital for endoscopic resection of rectal carcinoid, were reviewed, retrospectively. RESULTS: Thirty-three cases were treated by ESMR-L, and 55 cases by conventional polypectomy. There were no significant difference in the size of tumor between ESMR-L group and polypectomy group (6.02+/-2.36 vs. 6.49+/-3.24 mm, p=0.474). The rate of positive resection margin was significantly lower in ESMR-L group (2/33, 6.1%) than in polypectomy group (19/55, 34.5%; p=0.002). The rate of positive vertical resection margin, among others, was markedly lower in ESMR-L group (1/33, 3.0%) compared to polypectomy group (19/55, 34.5%; p<0.001). CONCLUSIONS: ESMR-L, rather than conventional polypectomy, is a useful treatment option for removal of rectal carcinoid tumors less than 10 mm in diameter.

Diagnosis and treatment of rectal carcinoid / 中华内分泌外科杂志

Objective To investigate the diagnosis and treatment of rectal carcinoid. Methods Clinical data of 16 patients of rectal carcinoids in our hospital from January 2000 to December 2009 were analyzed retrospectively. Related literatures were reviewed. Results Among the patients included, 11 cases(68.8%)suffered from hypogastralgia, 3 cases(18.8%)bloody stool, 3 cases(18.8%)defecation number increase. All the patients underwent enteroscopy. The average size in diameter of all the tumors was 8.8 mm. 81.3% of the tumors ≤10 mm in diameter. The average distance from tumor to anus was 6.8 cm and 87.5% of the tumors ≤8 cm in distance, Only 25% of all the cases were diagnosed preoperatively, most cases were diagnosed as other diseases and definitely diagnosed by postoperative pathology. 14 cases underwent operation as radical resection of rectal carcinoma, and 2 cases endoscopic removal. There was no operative death and postoperative five-year survival rate is 69.2%. Conclusions Preoperative diagnosis rectal carcinoid is difficult.Misdiagnosis rate is high. The key point of improving diagnosis of this disease is annal digital examination. Enteroscopy and pathology, operation is the first choice to treat rectal carcinoid.

Three Cases of Endoscopic Mucosal Resection of Rectal Carcinoid Tumor by Band Ligation and the Snare Resection Technique / 대한소화기내시경학회지

Many reports have shown that endoscopic polypectomy or endoscopic mucosal resection can successfully remove tumor less than 1.0 cm in size. However, most carcinoid tumors in the rectum occur in the submucosal layer so that the entire tumor cannot be completely removed via endoscopic polypectomy or endoscopic mucosal resection. Endoscopic mucosal resection can also cause perforation of the intestinal wall and bleeding. Due to these reasons, instead of these two conventional methods, endoscopic mucosal resection using a ligation device is currently being used for the treatment of rectal carcinoid tumor. Recent studies that used this method have reported that endoscopic mucosal resection of rectal carcinoid tumor by band ligation and the snare resection technique is safe with minimal complications and this is quite useful to completely remove rectal carcinoid tumor.

Current status of diagnosis and treatment of rectal carcinoids / 国际外科学杂志

Rectal carcinoid tumors are potential malignant and have been considered to be rare for a long time.But in recent years,the incidence has been increasing gradually,maybe due to the development of endoscopic technology,the widespread use of endoscopy for screening and the raising level of awareness.Because of the malignant tendency,early diagnosis and treatment are the most important things for patients.Nowadays,the misdiagnosis rate is still high and it is difficult to make differential diagnosis between benign and malignant tumors.The efficiency of chemotherapy and radiotherapy is not clear.Surgery is the only effective method,but there is no uniform standard for the choice of operation.At present,it is appropriate to consider tumor size,depth of invasion,lymph node,pathological type and other risk factors to determine a surgical modality.Colonoscopy is recognized to be the best means by follow-up and should be carried out regulady in a longer period of time.Therefore,it is important to summarize the diagnosis and treatment of rectal carcinoid.

A Small Rectal Carcinoid Tumor with Multiple Liver Metastases / 대한소화기내시경학회지

Rectal carcinoid tumors are relatively uncommon and make up 1~2% of tumors found in the rectum. Approximately 50% of the tumors are asymptomatic and are found incidentally. In most cases, the tumors are slowly growing in nature and thus have a favorable outcome. Anywhere from 66 to 80% of rectal carcinoid tumors are smaller than 1 cm and rarely metastasis. However, malignant behavior, such as invasion to the muscle wall, and metastasis to a distant organ, may be seen infrequently with tumors greater than 2 cm in size. The liver is the most common site of a metastasis. We experienced a case of a 1 cm sized small rectal carcinoid tumor with multiple liver metastases.

Transanal local excision of carcinoid tumors in the upper rectum under proctoscope: A clinical report of 6 cases / 中国微创外科杂志

Objective To study surgical techniques and clinical effects of minimally invasive excision of high rectal carcinoid tumors with anus preservation. Methods We conducted transanal local excision of rectal carcinoid tumors in 6 cases by using self-made proctoscope and laparoscopic instruments from August 2002 to January 2005. The tumors were located on the depth of 9~12 cm from the anal verge, and excision margin was 0.5~1 cm from the tumors. Results All the operations were performed successfully. A follow-up for 3~28 months (mean, 15 months) found no recurrence, metastasis, rectal stenosis, or other short- or long-term complications. The postoperative hospital stay was 3~6 days. No analgesics were required. Conclusions Transanal local excision of high rectal carcinoid tumors under proctoscope is safe, reliable, minimally invasive, and cost-effective.

Features of endoscopic ultrasonography in rectal carcinoids / 中华消化内镜杂志

Objective In order to improve the diagnostic accuracy for rectal carcinoid, features of endoscopic ultrasonography ( EUS) in rectal carcinoid were studied. Methods Twenty-nine consecutive ca-ses of rectal mucosal or submucosal mass were collected. EUS and pathologic examinations were performed. EUS images of rectal carcinoid confirmed by pathology were analyzed to find out their characteristic features. Results A total of 29 regions of interest ( ROIs) were detected in 29 patients, including 12 carcinoid le-sions, 11 adenomatous and 6 inflammatory lesions. Ten of the 12 rectal carcinoid lesions were hypoechoic, and the rest isoechoic; five of them were mucosal and 7 submucosallesions; all of the 12 lesions had well de-fined boundaries. Conclusion The characteristic features of EUS images of rectal carcinoids include well-defined boundary, homogeneous echo in submucosa or mucosa, and most of them are hypoechoic nodules. These EUS characteristic features greatly facilitate the early diagnosis of rectal carcinoid.

Rectal Carcinoid: Effectiveness of Endoscopic Resection

PURPOSE: Small-sized carcinoids, less than 1 cm, are easily detected using flexible sigmoidoscopy or total colonoscopy and can be treated by local excision. Recently, there has been many advances in the technique of endoscopic resection. The aim of this study was to determine the endoscopic findings of a rectal carcinoid and to evaluate the effectiveness of endoscopic resection. METHODS: We experienced 22 rectal carcinoids in 21 patients who were treated by endoscopic resection from June 1996 to February 1999. Nineteen cases were followed for an average of 21 months. Follow-up studies consisted of chest P-A, hepatic ultrasonography, and total colonoscopy. RESULTS: The male-to-female ratio was 1.6 to 1. The most common age group was the 4th decade. The tumor was located at the lower rectum in 10 patients, at the upper rectum in 10 patients, and at the rectosigmoid junction in 2 patients. The tumor sizes ranged from 3 to 12 mm in diameter and were smaller than 10 mm in 20 cases (90.1%). Endoscopic finding revealed that the tumors were covered by a normally appearing mucosa in 12 cases, were yellow-discolored polyps in 17 cases, and were sessile-type tumors in 19 cases. The method of treatment was an endoscopic mucosal resection (EMR, 14 cases) or a snare polypectomy (8 cases). Microscopically positive margins were noticed in four cases, two cases of EMR (2/14, 14%) and two cases of snare polypectomy (2/8, 25%). All the patients were alive and clinically free of disease; however, the duration of the follow-up is short. CONCLUSIONS: Endoscopic resection for rectal carcinoid tumors smaller than 1 cm in diameter is a safe, functional, time-saving, and effective treatment. If the tumor suggests a carcinoid, EMR is advised rather than a polypectomy even though the tumor is small. Microscopically positive margins are not absolute indications for further surgery in the treatment of carcinoids smaller than 1 cm in diameter. It is much more important for an endoscopist to be confident that the endoscopic resection is done completely. It is necessary to identify the factors influencing the malignancy potential and to have a longer follow-up.

The Clinical Value of Endoscopic Ultrasonography (EUS) in Rectal Carcinoid Tumor / 대한소화기내시경학회지

BACKGROUND/AIMS: Carcinoid tumor of the rectum is relatively uncommon lesion with malignant potential, representing 17-27% of gastrointestinal tract carcinoid. The selection of treatment in rectal carcinoid tumor is determined by the depth of invasion and the presence of metastasis. In this study, we evaluated the clinical utility of EUS in selecting the management of the rectal carcinoid tumor. METHODS: Total 8 patients with rectal carcinoid tumor diagnosed by means of colonoscopy and EUS from 1994 to 1999 were included in this study. None had specific symptoms of carcinoid syndrome. The treatment modality of all tumors were selected by EUS before resection. We examined histologic feature after resection of tumors in order to evaluate the effectiveness of EUS. RESULTS: In total 8 patients, the image of tumors was oval to round. The internal echo was generally hypoechoic and homogenous. The margins were clearly visualized, and the contour was somewhat smooth. All tumor were resected completely. The overall accuracy of determining the depth of invasion using endoscopic ultrasonography was 87% (7 of 8 lesions). CONCLUSIONS: EUS is considered to be helpful in evaluating the malignant behavior of rectal carcinoid tumor. It is suggested that the criteria of the selection based on the EUS findings is available in the choice of treatment for rectal carcinoid tumor.

The diagnosis and treatment of rectal carcinoid: a report of 43 cases / 中国癌症杂志

Purpose:To study the clinical and pathologica l features of rectal carcinoid and factors influencing the prognosis.Metho ds:Data of 43 rectal carcinoid patients were analyzed retrospectively.4 2 patients were followed up postoperatively. Primary tumors were classified by s ize and muscularis invasion respectively.Results:The 5-year su rvival rate was 100% for the patients with tumor 2cm. the 5-year survival rate was 100% for the patients without muscularis invasion, and 50% for those with muscularis invasion.Conclusions:Tumor size and muscularis invasion are important pr ognostic factors for rectal carcinold.

Rectal Carcinoid

PURPOSE: This study was designed to evaluate the clinical charateristics, surgical treatment and outcome of carcinoid tumors of the rectum. METHODS: A retrospective review of the charts of all patients treated for rectal carcinoid tumors at Kangbuk Samsung Medical Center between Jan 1989 and April 1998. Thirteen patients with rectal carcinoids tumors were treated. Follow-up data, histopathological information and surgical procedures were obtained from case notes. RESULTS: There were 10 men and 3 women. The ages ranged from 28 to 60 years (mean 41.1 years for all, 43.8 years for men and 32 years for women). Eight patients (61.5%) had no symptoms. Of the five patients, four complained of rectal bleeding (30.8%), and one complained of defecational difficulty (7.7%). Size of rectal carcinoid tumor was less than 1 cm in 7 patients (53.8%), between 1 cm and 2 cm in 2 patients (15.4%), in four patients (30.8%) larger than 2 cm. Three patients were treated in Abdominoperineal resection. Two patients underwent stapled low anterior resection. The remaining 8 patients underwent conservative resection (3 colonoscopic polypectomy and electrocauterization, 2 colonoscopic snaring biopsy, 2 transanal resection and one Mason's operation). The depth of invasion was contained within sutmucosa in 3 patients. Liver metastasis was found in 2 patients. Average follow-up time was 35.6 months. Two patients died of mutiple mestastasis (liver, bone, peritoneum) 9 and 30months later. CONCLUSION: We concluded that tumors smaller than 1 cm could be managed by local treatment whereas larger than 2 cm should be managed by radical treatment.