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
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