Endoscopic Submucosal Resection with Double Ligation Technique for Treatment of Small Rectal Carcinoid Tumors

Background and Study Aims: It is difficult to achieve complete endoscopic resection of rectal carcinoid tumors without any procedure-related complications. In this study, we evaluated the efficacy and safety of endoscopic submucosal resection with double ligation (ESMR-DL) for the treatment of small rectal carcinoid tumors.
Patients and Methods: Eleven rectal carcinoid tumors (in 11 patients) were resected by ESMR-DL between November 2001 and April 2004, using a conventional single-channel endoscope with an attached band-ligator device. The lesion was aspirated into the ligator device and an elastic band was placed around the base; a detachable snare was then used to ligate the stalk below the elastic band; and snare resection was performed above the elastic band. The resected specimens were examined with respect to size, histological atypia, depth of invasion, and the histological appearance of the resection margins.

Results: All the lesions were excised completely without any complications. There was no tumor invasion beyond the submucosal layer and there was no evidence of atypia in any of the specimens. Tumor diameter varied from 2.0 mm to 10.0 mm (average 6.2 mm). None of the 11 specimens showed histopathological evidence of tumor involvement at the resection margins. There were no immediate or late complications (bleeding or perforation) after ESMR-DL. There was no local recurrence and there were no distant metastases in any patients during the mean follow-up period of 18 months.
Conclusion: Endoscopic submucosal resection with double ligation is a useful and safe method for the treatment of small rectal carcinoid tumors.

References

• 1 Ishikawa H, Imanishi K, Okuda S. et al . Effectiveness of endoscopic treatment of carcinoid tumors of the rectum.  Endoscopy. 1989;  21 133-135
• 2 Berkelhammer C, Jasper I, Kirvaitis E. et al . ”Band-snare“ resection of small rectal carcinoid tumors.  Gastrointest Endosc. 1999;  50 582-585
• 3 Matsui K, Iwase T, Kitagawa M. Small polypoid-appearing carcinoid tumors of the rectum: clinicopathologic study of 16 cases and effectiveness of endoscopic treatment.  Am J Gastroenterol. 1993;  88 1949-1953
• 4 Yoshikane H, Goto H, Niwa Y. et al . Endoscopic resection of small duodenal carcinoid tumors with strip biopsy technique.  Gastrointest Endosc. 1998;  47 466-470
• 5 Jetmore A B, Ray J E, Gathraight J B. et al . Rectal carcinoids: the most frequent carcinoid tumor.  Dis Colon Rectum. 1992;  35 717-725
• 6 Kobayashi K, Katsumata T, Yoshizawa S. et al . Indications of endoscopic polypectomy for rectal carcinoid tumors and clinical usefulness of endoscopic ultrasonography.  Dis Colon Rectum. 2005;  48 285-291
• 7 Matsumoto T, Iida M, Suekane H. et al . Endoscopic ultrasonography in rectal carcinoid tumors: contribution to selection of therapy.  Gastrointest Endosc. 1991;  37 539-542
• 8 Matsushita M, Takakuwa H, Nishio A. Management of rectal carcinoid tumors.  Gastrointest Endosc. 2003;  58 641
• 9 Kajiyama T, Hajiro K, Sakai M. et al . Endoscopic resection of gastrointestinal submucosal lesions: a comparison between strip biopsy and aspiration lumpectomy.  Gastrointest Endosc. 1996;  44 404-410
• 10 Imada-Shirakata Y, Sakai M, Kajiyama T. et al . Endoscopic resection of rectal carcinoid tumors using aspiration lumpectomy.  Endoscopy. 1997;  29 34-38
• 11 Oshitani N, Hamasaki N, Sawa Y. et al . Endoscopic resection of small rectal carcinoid tumors using an aspiration method with a transparent overcap.  J Int Med Res. 2000;  28 241-246
• 12 Akiyama M, Ota M, Nakajima H. et al . Endoscopic mucosal resection of gastric neoplasm using a ligating device.  Gastrointest Endosc. 1997;  45 182-186
• 13 Suzuki Y, Hiraishi , Kanke K. et al . Treatment of gastric tumors by endoscopic mucosal resection with a ligating device.  Gastrointest Endosc. 1999;  49 192-198
• 14 Fleischer D E, Wang G O, Dawsey S. et al . Tissue band ligation followed by snare resection (band and snare): a new technique for tissue acquisitions in the esophagus.  Gastrointest Endosc. 1996;  44 68-72
• 15 Akiko O, Takahiro F, Yutaka S. et al . Endoscopic submucosal resection of rectal carcinoid tumors with a ligation device.  Gastrointest Endosc. 2003;  57 583-587