Double-snare-assisted endoscopic mucosal resection of a rectal neuroendocrine tumor through a single-channel endoscope

Endoscopic resection is the preferred treatment for small rectal neuroendocrine tumors (NETs) without evidence of metastasis [1]. The double-snare resection (DSR) technique using a double-channel endoscope has recently been reported to be a simple, safe, and inexpensive method of resecting rectal NETs [2]. However, the double-channel endoscope is not available in many endoscopy centers. We describe a new modified double-snare resection technique through a single-channel endoscope ([Fig. 1], [Video 1]).

Fig. 1 Schematic representation of the modified double-snare resection technique. a The resection snare was placed around the transparent cap on the outside of the endoscope. b The capture snare was introduced through the endoscope channel. c The lesion was grasped and lifted by the capture snare. d The resection snare was released, and placed around the base of the lesion.

Endoscopic mucosal resection with a modified double-snare technique for the treatment of a rectal neuroendocrine tumor.Video 1

An 80-year-old man underwent colonoscopy because of constipation. A subepithelial tumor-like lesion was detected in the rectum with typical features of NET ([Fig. 2] a). The lesion was resected through the modified DSR technique in the following steps. First, a polypectomy snare (“resection snare”) was placed around the transparent cap on the outside of the endoscope. The steel ring was tightened before entering the rectum. Next, a second snare (“capture snare”) was introduced through the endoscope channel after entering the rectum. The lesion was grasped and lifted by the capture snare ([Fig. 2] b). Then, the resection snare was released, passed over the capture snare, and placed around the base of the lesion ([Fig. 2] c). The lesion was completely resected by the resection snare using cutting electrosurgical current and was taken out by the capture snare. A clean and small wound was seen ([Fig. 2] d) and closed with clips ([Fig. 2] e). En bloc resection was achieved without adverse events ([Fig. 2] f).

Fig. 2 Endoscopic resection of a rectal neuroendocrine tumor (NET) using the modified double-snare resection technique. a A subepithelial tumor-like lesion was detected in the rectum with typical features of NET. b The lesion was grasped and lifted by the capture snare. c The resection snare was released and placed around the base. d The wound was clean and small after resection. e The wound was closed with clips. f The specimen was intact.

The pathology showed NET, G1, with a maximum tumor diameter of 7 mm (ly0, v0, pHM0, pVM0) ([Fig. 3] a). Immunohistochemical staining showed the tumor cells were positive for Syn ([Fig. 3] b), CD56 ([Fig. 3] c), and SSTR2 ([Fig. 3] d).

Fig. 3 Pathology demonstrated a neuroendocrine tumor. a Hematoxylin and eosin staining. b–d Immunohistochemical findings: b Syn, c CD56, d SSTR2.

The modified DSR technique through a single-channel endoscope incorporates the advantages of the DSR technique and previously reported clip-and-snare-assisted EMR technique [3]. It is simple to perform, saves time and cost, and can be achieved with only a single-channel endoscope.

Endoscopy_UCTN_Code_CCL_1AD_2AJ

Publikationsverlauf

Artikel online veröffentlicht:
26. Mai 2025

• References

• 1 Rinke A, Ambrosini V, Dromain C. et al. European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for colorectal neuroendocrine tumours. J Neuroendocrinol 2023; 35: e13309
• 2 Sánchez ÁR, Tamargo FG, Carbonell-Blanco C. et al. Double-snare resection technique: a new approach for treating rectal carcinoid tumors. Endoscopy 2024; 56: E454-E455
• 3 Liu WH, Liu S, Gong Y. et al. Cut the weeds and dig up the roots: clip-and-snare assisted endoscopic mucosal resection of a rectal neuroendocrine tumor. Endoscopy 2021; 53: E13-E14