CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(01): E4-E8
DOI: 10.1055/a-1300-1017
Original article

Endoscopic resection is more effective than biopsy or EUS to detect residual rectal neuroendocrine tumor[*]

Matthew W. Stier
1   University of Chicago Center for Endoscopic Research and Therapeutics (CERT), Chicago, Illinois, United States
Christopher G. Chapman
1   University of Chicago Center for Endoscopic Research and Therapeutics (CERT), Chicago, Illinois, United States
Steven Shamah
1   University of Chicago Center for Endoscopic Research and Therapeutics (CERT), Chicago, Illinois, United States
Kianoush Donboli
1   University of Chicago Center for Endoscopic Research and Therapeutics (CERT), Chicago, Illinois, United States
Lindsay Yassan
2   Department of Pathology, the University of Chicago Medicine, Chicago, Illinois, United States
Irving Waxman
1   University of Chicago Center for Endoscopic Research and Therapeutics (CERT), Chicago, Illinois, United States
Uzma D. Siddiqui
1   University of Chicago Center for Endoscopic Research and Therapeutics (CERT), Chicago, Illinois, United States
› Author Affiliations


Background and study aims Rectal neuroendocrine tumors (NETs) are often discovered incidentally and may be misidentified as adenomatous polyps. This can result in a partial resection at the index procedure, and lesions are often referred for staging or evaluation for residual disease at the resection site. The aim of this study was to identify the ideal method to confirm complete excision of small rectal NETs.

Patients and methods Data from patients with a previously resected rectal NET referred for follow-up endoscopy or endoscopic ultrasound (EUS) were retrospectively reviewed. Univariate analysis was performed on categorical data using the Chi-squared test.

Results Forty-nine patients with rectal NETs were identified by pathology specimens. Of those, 39 underwent follow-up endoscopy or EUS and were included. Baseline characteristics included gender (71 % F, 29 % M), age (57.2 ± 13.4 yrs) lesion size (7.3 ± 4.2 mm) and location. The prior resection site was identified in 37/39 patients who underwent tissue sampling. Residual NET was found histologically in 14/37 lesions. All residual disease was found during salvage endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) and 43 % had a normal-appearing scar. Every patient undergoing EUS had an unremarkable exam. Initial cold biopsy polypectomy (P = 0.006), visible lesions (P = 0.001) and EMR/ESD of the prior resection site (P = 0.01) correlated with residual NET.

Conclusions Localized rectal NETs may be incompletely removed with standard polypectomy. If an advanced resection is not performed initially, repeat endoscopy with salvage EMR or ESD of the scar should be considered. For small rectal NETs, biopsy may miss residual disease when there is no visible lesion and EUS appears to have no benefit.

* Meeting presentations: Digestive Disease Week 2018

Publication History

Received: 01 April 2020

Accepted: 05 October 2020

Article published online:
01 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (

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