Endoscopic Mucosal Resection And Cap-assisted Endoscopic Mucosal Resection For Treatment Of Rectal Carcinoid Tumours

Objective To analyze the features of rectal carcinoid tumors underendoscopy and endoscopic ultrasound（EUS），to investigate the efficacyand safety of endoscopic mucosal resection (EMR) or cap-assisted EMR(EMRC) for the treatment of rectal carcinoid tumors.Methods Data of77patients with rectal carcinoids confirmed bycolonoscopy and pathology in the Endoscope Center of China JapanUnion Hospital of Jilin University from January2010to December2014were analyzed retrospectively. Morphologic characteristics，endoscopictreatments such as EMR or EMRC and prognosis were summarized.Results All the lesions located in a distance of2-10cm from theanus dentate line to the rectum．The diameters of removed lesions were0.3-1.0cm. The lesions presented mainly with broad-based semisphere orflat bulg，most were yellow-white，with smooth surface，integratedmucose，clear boundary，good activity range. All groups of rectalcarcinoid had EUS，showing that the lesions rooted in muscularis mucosaand (or) sub-mucosa，with changes of hypoechoic or mixed echo，echowithin lesion being well-or poorly-distributed．Of77cases，35underwentEMR，and42underwent EMRC．There were two cases bleeding afterEMR（5.7%）, three after EMRC（7.1%）. There was no statisticaldifference (P>0.05). No complications such as massive hemorrhage andperforation occurred in two groups. All the tumors were localized withinthe submucosal layer showing typical histology without lymphatic orvassel infiltration. The positive rates of CgA and Syn were53%and90%，and75%in NSE.Eight cases occured tumor residue after EMR(22.9%)，one case after EMRC (2.4%). All of them underwent an additional surgical operation. The pathological complete resection rate inthe EMRC was97.6%，and in the EMR was77.1%，it seems that theformer was higher than the latter，and there was statistical difference(P<0.05). According to EUS，there were17lesions from the second andthe third layer underwent EMR, and25underwent EMRC. Of all theselesions underwent EMR,10were completely resected (58.8%), the otherswere not. And there were24in EMRC (96.0%). It seems that in theselayers EMRC got a higher pathological complete resection rate，and therewas statistical difference (P<0.05). Sixty-five patients were followed upsuccessfully (84.4%)，the follow-ups lasted3months to2years. Nodeath，recurrence or metastasis occurred during follow-up.Conclusions Rectal carcinoid can be diagnosed with endoscopy.Patients with rectal carcinoids less than1cm in diameter, localized to themucosa or submucosa, may be safely and effectively resected byendoscopy. Compared with EMR，EMRC might be in favor of completeexcision for the lesions of carcinoids，decrease recurrence and have thesafety no less than EMR. EMRC can yet be regarded as an effectivetreatment for smaller rectal carcinoid tumors．EUS can be a guideline forchoosing treatment therapy.