Clinical Study Of Endoscopic Submucosal Dissection Treatment Of Rectal Neuroendocrine Neoplasm

Objective:Neuroendocrine neoplasms(NENs)are a group of fairly rare tumors whose incidence is keeping increased.To evaluate the clinical value of endoscopic ultrasonography(EUS)in the diagnosis of rectal neuroendocrine tumors and the efficacy and safety of endoscopic submucosal dissection(ESD)in the treatment of rectal neuroendocrine tumors.Method:In this study,18 cases of rectal neuroendocrine neoplasms were retrospectively analyzed from January 2013 to June 2018 at the 309th PLA Hospital.Patients'endoscopic and pathological features,clinical manifestations,follow-up results were studied.The analysis included:routine electronic colonoscopy for initial diagnosis;endoscopic ultrasonography(EUS)for guiding the extent and depth of ESD resection;ESD for rectal neuroendocrine neoplasms,endoscopic marking of the scope of pre-resection,submucosal injection,mucosal incision,lesion dissection and wound management;postoperativeroutine pathologymanagement andimmunohistochemical examination.Result:The diameters of rectal neuroendocrine tumors in 18 cases ranged from 0.5 to 1.2 cm,with an average diameter of 0.6±0.2cm.ESD was completely dissected without perforation.6 cases were bleeding during operation,and Dualknife knife electrocoagulation was used to stop bleeding.No carcinoid tissue was found in the base of the lesion and the incision margin of the lesion Immunohistochemical examination showed that Syn94.4%(17/18),CgA 83.3%(15/18),NSE 44.4%(8/18),CEA0.0%(0/18)and p53.0%(0/18),which suggested the diagnosis of rectal neuroendocrine neoplasms and the prognosis is good.During the follow-up 1-60 months,no recurrence case was found.Conclusion:EUS is able to distinguish the origin of rectal NENs and aid determining the range and depth of ESD.ESD is safe and effective in patients with rectal neuroendocrine tumors whose diameter is less than 1.2cm and causes less complications.Tumor features and stage determine the risk of distant metastasis,so long-term follow-up is essential.