The saline-immersion/irrigation technique to facilitate endoscopic submucosal/intermuscular dissection of rectal neuroendocrine tumours

Aims Rectal neuroendocrine tumours (R-NETs) can be effectively and safely treated with endoscopic submucosal dissection (ESD) as previously reported [1] [2] [3]. In our center, saline-immersion/irrigation technique (SITE) facilitated ESD / endoscopic intermuscular dissection (EID) is routinely used for resection of colorectal lesions. The aim of this study was to demonstrate that SITE-ESD is effective for resection of R-NETs conferring the several intrinsic advantages of the technique.

Methods This study retrospectively analyzed our prospective database for consecutive patients referred to our centre for ESD of R-NETs from March 2018 to October 2024. Relevant demographics, size of R-NETs, histological type, presence of lymphovascular invasion or distant metastasis, completeness of the endoscopic resection, recurrence, and adverse events were recorded.

Results A total of 24 patients were included in the analysis: 16 (66.7%) R-NETs for primary resection and 8 (33.3%) scars after previous positive margin (R1) endoscopic mucosal resection. Mean age was 45.54 (SD 15.16, range 21-76), 50% were men (n=12). Median ASA score was 1 (IQR 1-2, range 1-2); median maximum diameter for the R-NETs was 6.5 mm (IQR 4,25-8, range 1-10). Median resection time was 72.5 minutes (IQR 46,25-90, range 2-210). All procedures were completed with SITE-ESD combined with variations of the pocket-creation method (PCM) (75% (18/24)) or the circumferential approach (4.2% (1/24)), and EID in 20.8% (5/24). R0 resection was achieved in 93.8% (15/16) of the procedures for primary resection of R-NETs, one patient with R1 resection had no recurrence at 48 months follow-up. Endoscopic follow-up was completed in 87.5% (14/16) of patients at the time of study; no recurrences were observed. For scars of R-NETs with positive resection margins at previous EMR, histopathology of the specimens post-SITE-ESD confirmed clearance of any pathology. No significant adverse events occurred.

Conclusions Our experience with SITE-ESD/EID for R-NETs and for scars of previous incomplete resection is encouraging and suggests that further studies to evaluate its incorporation into wider clinical practice would be worthy of merit.

 

MissingLinkText

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, Repici A, Vieth M, De Ceglie A. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-54
• 2 Deprez PH, Moons LMG, OʼToole D, Gincul R, Seicean A, Pimentel-Nunes P, Fernández-Esparrach G, Polkowski M, Vieth M, Borbath I, Moreels TG, Nieveen van Dijkum E, Blay JY, van Hooft JE. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54 (4): 412-429 Epub 2022 Feb 1835180797
• 3 Rinke A, Ambrosini V, Dromain C, Garcia-Carbonero R, Haji A, Koumarianou A. et al. European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for colorectal neuroendocrine tumours. J Neuroendocrinol 2023; 35: e13309

Publication History

Article published online:
27 March 2025