Outcome of Endoscopic Submucosal Dissection for Rectal Neuroendocrine Neoplasms: a multicentre study

Aims Recent guidelines recommend advanced endoscopic resection techniques, such as Endoscopic Submucosal Dissection (ESD), for the treatment of rectal neuroendocrine neoplasms (R-NENs) under 15mm due to high rate of positive margins at Endoscopic Mucosal Resection (EMR) (1,2). Data for supporting ESD on R-NENs are scarce. We retrospectively ruled in a western cohort of patients who had ESD for R-NENs and a post ESD endoscopic follow-up to evaluate its efficacy.

Methods Patients from eight western international tertiary referral centres were enrolled in the study. Adverse events, R1 rate and recurrences were analysed. Baseline demographics, as well as tumour characteristics and peri and post procedural adverse events were recorded. Given the retrospective nature of the study, follow up endoscopic time was not standardized.

Results A total of 40 ESD procedures were performed in 39 patients. Mean lesion size was 10.4 mm (SD 4.0, range 8.0-20.0), with 15% of the lesion >15mm. ESD was feasible in all procedures, with a 97.5% en-bloc resection rate. In one case the ESD was not curative. The overall rate of peri-procedural complications was 7.5%, including 1 case of perforation (2.5%) which was managed endoscopically without the need for adjunctive surgery. The rate of R1 was (3/40) 7.5%. A statistically significant relationship between the resection of R1 and Ki67 (OR 1.28, CI95% 1.04-1.68, p=0.03) was found. After a median follow up time of 20 months, recurrence occurred in 1/39 patients (2.5%), subsequently referred for surgery [1] [2].

Conclusions ESD is an effective treatment for resection of R-NENs. An optimal R0 resection rate with low peri-procedural complications was found. Further prospective studies are warranted.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• 1 de Mestier L, Lepage C, Baudin E. et al. Digestive Neuroendocrine Neoplasms (NEN): French Intergroup clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, GTE, RENATEN, TENPATH, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SFR). Dig Liver Dis 2020; 52 (05) 473-92
• 2 Deprez PH, Moons LMG, OʼToole D. et al. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54 (04) 412-429

Publication History

Article published online:
14 April 2023