The aim of this study is evaluating and safety and efficacy between the modified double snare EMR and ESD. It is intended to prove that for rectal neuroendocrine tumors within 1 cm, the complete resection rate of the mDS-EMR is not inferior to that of ESD, but may with shorter operation time, lower complication rate and lower treatment cost.
Typical rectal neuroendocrine tumors by endoscopy (within 15cm from the anal verge, yellowish subepithelial elevation with a smooth surface, and dilated blood vessels in some areas).
The maximum diameter of the lesion is smaller than 1cm by preoperative endoscopic assessment.
Lesion is located within the mucosal and submucosal layer by preoperative endoscopic assessment.
Patients can understand and sign the informed consent.
Poor coagulation function(PT>15 seconds or APTT>45 seconds or INR>2.0)
With severe cardiovascular or cerebrovascular diseases and cannot tolerate operation( with a history of stroke or myocardial infarction within the past month or with severe heart failure and cardiac function grade III)
Indication of metastasis by preoperative imaging examinations
With more than or equal to 2 rectal neuroendocrine tumors
Parallel
modified double snare assisted endoscopic mucosal resection
Procedure/SurgeryA polypectomy snare (resection snare) was placed outside of the endoscope. After approaching the lesion, a second polypectomy snare (capture snare) was inserted through the biopsy channel of the endoscope to grasp and lift the lesion. The snare preloaded outside of the endoscope was released, passed through the capture snare and positioned below the capture snare to grasp the base of the lesion. Once the lesion was securely grasped, it was resected by resection snare to achieve en bloc resection. The wounds were closed by clips.
endoscopic submucosal dissection
Procedure/SurgeryThe procedure includes submucosal injection of normal saline and methylene blue suspension, cutting and dissection by mucosal incision knife (such as Dual knife, Golden knife or Kunpeng knife, etc.) , hemostasis and sealing of the wound. Traction is allowed during the operation.
complete resection
Rate of complete en bloc resection with microscopically negative margins.
En bloc resection
Rate of complete resection as a single piece
operation success rate
Technical success was defined as the completion of procedure without abortion or conversion to other procedure
operation time
Operation time of ESD refers to the period from marking to completely removing the lesion, including submucosal injection, circumferential incision, submucosal dissection, additional submucosal injection and hemostasis during the operation and closure of the wound. Operation time of mDS-EMR refers to the period from the placing of the external snare to completely removing the lesion, hemostasis and closure of the wound.
Postoperative hospital stay
Period from the day of operation to discharge
Delayed perforation
Postoperative abdominal pain, along with pelvic infection. Free gas in the pelvic cavity can be observed by imaging examination.
Delayed bleeding
Hemorrhage occurs withing 30 days after the procedure that requires endoscopic, radiological, or surgical intervention, or a blood transfusion may be required.
Intraoperative bleeding
arterial bleeding or active oozing for more than 30 seconds during the operation, which required endoscopic, radiological, or surgical intervention.
Intraoperative perforation
Damage of muscular layer of rectal wall and a hole to extracavitary tissue can be observed by endoscopy.
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