Endoscopic mucosal resection using anchored snare Tip-in versus precut technique for small rectal neuroendocrine tumors

• Published in: The Korean journal of internal medicine Vol. 39; no. 2; pp. 238 - 247
• Main Authors: Hong, Seung Wook, Yang, Dong-Hoon, Lee, Yoo Jin, Baek, Dong Hoon, Chun, Jaeyoung, Kim, Hyun Gun, Kim, Sung Joo, Hong, Seung-Mo, Myung, Dae-Seong
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Association of Internal Medicine 01.03.2024; The Korean Association of Internal Medicine
• Subjects: endoscopic mucosal resection; Endoscopic Mucosal Resection - adverse effects; Humans; Intestinal Mucosa - diagnostic imaging; Intestinal Mucosa - pathology; Intestinal Mucosa - surgery; multicenter study; neuroendocrine tumors; Neuroendocrine Tumors - diagnostic imaging; Neuroendocrine Tumors - pathology; Neuroendocrine Tumors - surgery; Original; Prospective Studies; randomized controlled trial; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Retrospective Studies; Treatment Outcome; Endoscopic mucosal resection; Randomized controlled trial; Multicenter study; Neuroendocrine tumors
• ISSN: 1226-3303; 2005-6648
• DOI: 10.3904/kjim.2023.263

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. 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%. 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. 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.