Endoscopic mucosal resection with a ligation device or endoscopic submucosal dissection for rectal carcinoid tumors: An analysis of 24 consecutive cases

Aims: Endoscopic submucosal dissection (ESD) has several advantages over conventional endoscopic mucosal resection, including a higher en bloc resection rate and more accurate pathological estimation. However, ESD is a complex procedure that requires advanced endoscopic skills. The aim of our study is to evaluate the efficacy of endoscopic mucosal resection with a ligation device (EMR‐L) compared to ESD for rectal carcinoid tumors. Methods: Between September 2003 and April 2011, 24 rectal carcinoid tumors in 24 patients treated by ESD or EMR‐L were retrospectively analyzed. The indications for endoscopic treatment were node‐negative rectal carcinoid tumors. We compared the therapeutic outcomes of the ESD group (n = 13) and the EMR‐L group (n = 11). Results: Both groups had similar mean tumor sizes (ESD: 5.5 ± 2.1 mm; EMR‐L: 4.4 ± 2.2 mm). The rates of en bloc and complete resection were, respectively, 100% and 92.3% for ESD, and 100% and 100% for EMR‐L. Perforations did not occur in either group. Postoperative bleeding occurred in one EMR‐L case, and it was endoscopically managed. However, there were no differences in therapeutic outcomes between the two groups. The mean procedure time was longer in the ESD group (28.8 ± 16.2 min) than in the EMR‐L group (17.4 ± 4.4 min), without a significant difference. The mean hospitalization period was significantly shorter in the EMR‐L group (1.8 ± 3.1 day) than in the ESD group (6.2 ± 2.1 day), and eight EMR‐L cases were treated in an outpatient setting. Conclusions: EMR‐L is a simple and effective procedure that compares favorably to ESD for small rectal carcinoid tumors.