open access

Vol 71, No 4 (2020)
Review paper
Published online: 2020-08-14
Submitted: 2020-05-15
Accepted: 2020-06-17
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Endoscopic management of rectal neuroendocrine tumours. How to avoid a mistake and what to do when one is made?

Krzysztof Dąbkowski, Marek Szczepkowski, Beata Kos-Kudła, Teresa Starzynska
DOI: 10.5603/EP.a2020.0045
·
Pubmed: 32852049
·
Endokrynologia Polska 2020;71(4):343-349.

open access

Vol 71, No 4 (2020)
REVIEWS — Postgraduate Education
Published online: 2020-08-14
Submitted: 2020-05-15
Accepted: 2020-06-17

Abstract

Rectal neuroendocrine tumours are subepithelial lesions that are potentially malignant. Although the biology of these lesions has become increasingly understood and their management has been established, the endoscopic management of these tumours remains controversial.

Recent studies demonstrated that compliance with guidelines is poor, and the majority of rectal neuroendocrine tumours are removed by an improper method, making management more complex and putting patients at risk of metastatic spread. Thus, there is a need to educate physicians who care for patients with these disorders. Our review has some tips and pointers for preventing mistakes in primary treatment and salvage therapy after polypectomy. 

Abstract

Rectal neuroendocrine tumours are subepithelial lesions that are potentially malignant. Although the biology of these lesions has become increasingly understood and their management has been established, the endoscopic management of these tumours remains controversial.

Recent studies demonstrated that compliance with guidelines is poor, and the majority of rectal neuroendocrine tumours are removed by an improper method, making management more complex and putting patients at risk of metastatic spread. Thus, there is a need to educate physicians who care for patients with these disorders. Our review has some tips and pointers for preventing mistakes in primary treatment and salvage therapy after polypectomy. 

Get Citation

Keywords

rectal neuroendocrine tumours; endoscopic ultrasound; endoscopic submucosal dissection; transanal endoscopic microsurgery

About this article
Title

Endoscopic management of rectal neuroendocrine tumours. How to avoid a mistake and what to do when one is made?

Journal

Endokrynologia Polska

Issue

Vol 71, No 4 (2020)

Article type

Review paper

Pages

343-349

Published online

2020-08-14

DOI

10.5603/EP.a2020.0045

Pubmed

32852049

Bibliographic record

Endokrynologia Polska 2020;71(4):343-349.

Keywords

rectal neuroendocrine tumours
endoscopic ultrasound
endoscopic submucosal dissection
transanal endoscopic microsurgery

Authors

Krzysztof Dąbkowski
Marek Szczepkowski
Beata Kos-Kudła
Teresa Starzynska

References (49)
  1. Starzyńska T, Londzin-Olesik M, Bałdys-Waligórska A, et al. Colorectal neuroendocrine neoplasms - management guidelines (recommended by the Polish Network of Neuroendocrine Tumours). Endokrynol Pol. 2017; 68(2): 250–260.
  2. Chablaney S, Zator Z, Kumta N. Diagnosis and Management of Rectal Neuroendocrine Tumors. Clin Endoscop. 2017; 50(6): 530–536.
  3. de Mestier L, Brixi H, Gincul R, et al. Updating the management of patients with rectal neuroendocrine tumors. Endoscopy. 2013; 45(12): 1039–1046.
  4. Caplin M, Sundin A, Nillson O, et al. Barcelona Consensus Conference participants. ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms: colorectal neuroendocrine neoplasms. Neuroendocrinology. 2012; 95(2): 88–97.
  5. Ramage JK, De Herder WW, Delle Fave G, et al. Vienna Consensus Conference participants. ENETS Consensus Guidelines Update for Colorectal Neuroendocrine Neoplasms. Neuroendocrinology. 2016; 103(2): 139–143.
  6. Onozato Y, Kakizaki S, Iizuka H, et al. Endoscopic treatment of rectal carcinoid tumors. Dis Colon Rectum. 2010; 53(2): 169–176.
  7. Son HJ, Sohn DK, Hong CW, et al. Factors associated with complete local excision of small rectal carcinoid tumor. Int J Colorectal Dis. 2013; 28(1): 57–61.
  8. Judd S, Nangia S, Levi E, et al. Rectal carcinoid tumor: a delayed localized recurrence 23 years after endoscopic resection. Endoscopy. 2014; 46 Suppl 1 UCTN: E555–E556.
  9. Dąbkowski K, Białek A, Rusiniak-Rossińska N, et al. Endoscopic treatment of rectal neuroendocrine tumors in a 12 year retrospective single center study. ESGE Days 2019. 2019.
  10. Fine C, Roquin G, Terrebonne E, et al. Endoscopic management of 345 small rectal neuroendocrine tumours: A national study from the French group of endocrine tumours (GTE). United European Gastroenterol J. 2019; 7(8): 1102–1112.
  11. Cha JH, Jung DaH, Kim JH, et al. Long-term outcomes according to additional treatments after endoscopic resection for rectal small neuroendocrine tumors. Sci Rep. 2019; 9(1): 4911.
  12. Lee SP, Sung IK, Kim JH, et al. The effect of preceding biopsy on complete endoscopic resection in rectal carcinoid tumor. J Korean Med Sci. 2014; 29(4): 512–518.
  13. Kudo S, Hirota S, Nakajima T, et al. Colorectal tumours and pit pattern. J Clin Pathol. 1994; 47(10): 880–885.
  14. McGill SK, Evangelou E, Ioannidis JPA, et al. Narrow band imaging to differentiate neoplastic and non-neoplastic colorectal polyps in real time: a meta-analysis of diagnostic operating characteristics. Gut. 2013; 62(12): 1704–1713.
  15. Lahner E, Esposito G, Angeletti S, et al. Endoscopic appearances of polypoid type 1 gastric microcarcinoids by narrow-band imaging: a case series in a referral center. Eur J Gastroenterol Hepatol. 2016; 28(4): 463–468.
  16. Lin CK, Chung CS, Huang WC. Rectal carcinoid tumour observed by magnifying colonoscopy with narrow band imaging. Dig Liver Dis. 2014; 46(7): e7.
  17. Kobayashi K, Katsumata T, Yoshizawa S, et al. Indications of endoscopic polypectomy for rectal carcinoid tumors and clinical usefulness of endoscopic ultrasonography. Dis Colon Rectum. 2005; 48(2): 285–291.
  18. Ishii N, Horiki N, Itoh T, et al. Endoscopic submucosal dissection and preoperative assessment with endoscopic ultrasonography for the treatment of rectal carcinoid tumors. Surg Endosc. 2010; 24(6): 1413–1419.
  19. Park SuB, Kim DJ, Kim HW, et al. Is endoscopic ultrasonography essential for endoscopic resection of small rectal neuroendocrine tumors? World J Gastroenterol. 2017; 23(11): 2037–2043.
  20. Onozato Y, Kakizaki S, Iizuka H, et al. Endoscopic treatment of rectal carcinoid tumors. Dis Colon Rectum. 2010; 53(2): 169–176.
  21. Kim JH, Moon W, Park SJa, et al. Clinical impact of endoscopic ultrasonography for small rectal neuroendocrine tumors. Turk J Gastroenterol. 2014; 25(6): 657–660.
  22. Kwak MS, Chung SuJ, Yang JIn, et al. Long-term Outcome of Small, Incidentally Detected Rectal Neuroendocrine Tumors Removed by Simple Excisional Biopsy Compared With the Advanced Endoscopic Resection During Screening Colonoscopy. Dis Colon Rectum. 2018; 61(3): 338–346.
  23. Gleeson FC, Levy MJ, Dozois EJ, et al. Endoscopically identified well-differentiated rectal carcinoid tumors: impact of tumor size on the natural history and outcomes. Gastrointest Endosc. 2014; 80(1): 144–151.
  24. Zhou X, Xie H, Xie L, et al. Endoscopic resection therapies for rectal neuroendocrine tumors: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2014; 29(2): 259–268.
  25. Saclarides TJ, Smith L, Ko ST, et al. Transanal endoscopic microsurgery. Dis Colon Rectum. 1992; 35(12): 1183–1191.
  26. Meier B, Albrecht H, Wiedbrauck T, et al. Full-thickness resection of neuroendocrine tumors in the rectum. Endoscopy. 2020; 52(1): 68–72.
  27. Schmidt A, Bauerfeind P, Gubler C, et al. Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience. Endoscopy. 2015; 47(8): 719–725.
  28. Grauer M, Gschwendtner A, Schäfer C, et al. Resection of rectal carcinoids with the newly introduced endoscopic full-thickness resection device. Endoscopy. 2016; 48 Suppl 1: E123–E124.
  29. Klare P, Burlefinger R, Neu B, et al. Over-the-scope clip-assisted endoscopic full-thickness resection after incomplete resection of a rectal neuroendocrine tumor. Endoscopy. 2015; 47 Suppl 1 UCTN: E47–E48.
  30. Tashima T, Nonaka K, Ryozawa S. Successful endoscopic en bloc full-thickness and complete resection for two adjacent rectal neuroendocrine tumors. Dig Endosc. 2019; 31(5): 592.
  31. Kwaan MR, Goldberg JE, Bleday R. Rectal carcinoid tumors: review of results after endoscopic and surgical therapy. Arch Surg. 2008; 143(5): 471–475.
  32. Maeda K, Maruta M, Utsumi T, et al. Minimally invasive surgery for carcinoid tumors in the rectum. Biomed Pharmacother . 2002; 56(Suppl 1): 222s–226s.
  33. Kumar AS, Sidani SM, Kolli K, et al. Transanal endoscopic microsurgery for rectal carcinoids: the largest reported United States experience. Colorectal Dis. 2012; 14(5): 562–566.
  34. Chen WJ, Wu N, Zhou JL, et al. Full-thickness excision using transanal endoscopic microsurgery for treatment of rectal neuroendocrine tumors. World J Gastroenterol. 2015; 21(30): 9142–9149.
  35. Shao Q, Lin G, Qiu H. Transanal endoscopic microsurgery for treatment of rectal neuroendocrine tumors. Zhonghua Wei Chang Wai Ke Za Zhi. 2017; 20 (29): 1009–1014.
  36. Pagano N, Ricci C, Brighi N, et al. Incidental diagnosis of very small rectal neuroendocrine neoplasms: when should endoscopic submucosal dissection be performed? A single ENETS centre experience. Endocrine. 2019; 65(1): 207–212.
  37. Shah MH, Goldner WS, Halfdanarson TR, et al. NCCN Guidelines Insights: Neuroendocrine and Adrenal Tumors, Version 2.2018. J Natl Compr Canc Netw. 2018; 16(6): 693–702.
  38. Anthony LB, Strosberg JR, Klimstra DS, et al. North American Neuroendocrine Tumor Society (NANETS). The NANETS consensus guidelines for the diagnosis and management of gastrointestinal neuroendocrine tumors (nets): well-differentiated nets of the distal colon and rectum. Pancreas. 2010; 39(6): 767–774.
  39. Amin MB, Edge S. AJCC cancer staging manual. 8th ed. Springer, New York 2016.
  40. Kinoshita T, Kanehira E, Omura K, et al. Transanal endoscopic microsurgery in the treatment of rectal carcinoid tumor. Surg Endosc. 2007; 21(6): 970–974.
  41. Park HW, Byeon JS, Park YS, et al. Endoscopic submucosal dissection for treatment of rectal carcinoid tumors. Gastrointest Endosc. 2010; 72(1): 143–149.
  42. Yamaguchi N, Isomoto H, Nishiyama H, et al. Endoscopic submucosal dissection for rectal carcinoid tumors. Surg Endosc. 2010; 24(3): 504–508.
  43. Zhou PH, Yao LQ, Qin XY, et al. Advantages of endoscopic submucosal dissection with needle-knife over endoscopic mucosal resection for small rectal carcinoid tumors: a retrospective study. Surg Endosc. 2010; 24(10): 2607–2612.
  44. Lee DS, Jeon SW, Park SY, et al. The feasibility of endoscopic submucosal dissection for rectal carcinoid tumors: comparison with endoscopic mucosal resection. Endoscopy. 2010; 42(8): 647–651.
  45. Kim HR, Lee WY, Jung KUk, et al. Transanal endoscopic microsurgery for the treatment of well-differentiated rectal neuroendocrine tumors. J Korean Soc Coloproctol. 2012; 28(4): 201–204.
  46. Zhao ZF, Zhang N, Ma SR, et al. A comparative study on endoscopy treatment in rectal carcinoid tumors. Surg Laparosc Endosc Percutan Tech. 2012; 22(3): 260–263.
  47. Kim KM, Eo SJ, Shim SG, et al. Treatment outcomes according to endoscopic treatment modalities for rectal carcinoid tumors. Clin Res Hepatol Gastroenterol. 2013; 37(3): 275–282.
  48. Kaneko H, Hirasawa K, Koh R, et al. Treatment outcomes of endoscopic resection for rectal carcinoid tumors: an analysis of the resectability and long-term results from 46 consecutive cases. Scand J Gastroenterol. 2016; 51(12): 1489–1494.
  49. Zhang DG, Luo Su, Xiong F, et al. Endoloop ligation after endoscopic mucosal resection using a transparent cap: A novel method to treat small rectal carcinoid tumors. World J Gastroenterol. 2019; 25(10): 1259–1265.

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