EMR-P for small rectal neuroendocrine tumors: is it a preferred treatment?

Figures & data

Figure 1. Procedure for precut endoscopic mucosal resection. (A) Yellow hemispherical mass in the rectum; (B) Injection into the submucosal layer; (C) Circumferential resection; (D) Snaring of the lesion; (E) Mucosal defect after endoscopic submucosal dissection; (F) Clip closure of the mucosal defect.

Figure 2. Procedure for endoscopic submucosal dissection. (A) Yellow hemispherical mass in the rectum; (B) Injection into the submucosal layer; (C) Entry into the submucosa for dissection; (D) Mucosal defect observed after endoscopic submucosal dissection; (E) Clip closure of mucosal defect; (F) The excised specimen was treated and analyzed in a standardized manner.

Figure 3. Flowchart of patient enrollment. EMR: Endoscopic mucosal resection; EMR-P: Precut endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; IQR: Interquartile range.

Table 1. Comparison of the baseline clinical characteristics of patients in the EMR-P and ESD groups.

	All, 98	EMR-P group, n = 40	ESD group, n = 58	p Value
Age (year)
Median (IQR)	44.6 (26-74)	45.7 (27-79)	46.3 (25-75)	.13
Sex, n (%)
Male	51 (52.04)	17 (42.50)	34 (58.62)	.01
Female	47 (47.96)	23 (57.50)	24 (41.38)
Distance from the perianal skin, n (%)
>7 mm	16 (16.33)	6 (15.00)	10 (10.20)	.28
≤7 mm	82 (83.67)	34 (85.00)	48 (89.80)
Morphology, n (%)				.63
Flat	15 (15.31)	6 (15.00)	9 (15.52)
Hemispherical	83 (84.69)	34 (85.00)	49 (84.48)
Tumor size, mm
Median (IQR)	6 (2-10)	5 (2-7)	6 (3-10)	.21
>5 mm	37 (37.76)	18 (45.00)	25 (43.10)	.15
≤5 mm	61 (62.24)	22 (55.00)	33 (56.90)

P values were calculated using Fisher’s exact test for categorical data and the Mann–Whitney U test for continuous data. EMR-P: Precut endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; IQR: Interquartile range.

Table 2. Comparison of the treatment results between EMR-P and ESD.

	EMR-P group, n = 40	ESD group, n = 58	p Value
Operation time, min
Median (IQR)	5.5 (4-9.5)	32 (25-94.5)	<.001
En bloc resection, n (%)	39 (97.50)	57 (98.28)	.29
Complete resection, n (%)	34 (85.00)	48 (82.76)	.18
radical resection, n (%)	34 (85.00)	48 (82.76)	.18
Adverse events, n (%)	1 (2.50)	2 (3.45)	.21
Delayed perforation, n (%)	0 (0.00)	1 (1.72)	1
Delayed bleeding, n (%)	1 (2.5)	1 (1.72)	1
Hospital stay, d
Median (IQR)	5 (3-7)	7 (5-11)	.01
Follow-up duration, mo
Median (IQR)	34 (4-90)	38 (4-92)	.72
Local recurrence, n (%)	0 (0.00)	0 (0.00)	1
Metastatic recurrence, n (%)	0 (0.00)	0 (0.00)	1
Positive margin, n (%)
Vertical margin, n (%)	5 (12.50)	7 (12.01)	.36
Horizontal margin, n (%)	2 (5.00)	4 (6.90)	.28

P-values were calculated using Fisher’s exact test for categorical data and the Mann–Whitney U-test for continuous data. EMR-P: precut endoscopic mucosal resection; ESD: endoscopic submucosal dissection; IQR: interquartile range.