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.

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.