Endoscopic submucosal resection using a ligation band without injection for rectal neuroendocrine tumors (with video).

BACKGROUND AND AIMS: The most appropriate endoscopic resection procedure for small rectal neuroendocrine tumors (NETs) remains unclear. We aimed to evaluate the usefulness of endoscopic submucosal resection using a ligation band (ESMR-L) without submucosal injection compared to ESMR-L with submucosal injection.

METHODS

This single-center retrospective study included rectal NETs (≤10 mm) treated with ESMR-L between March 2017 and July 2024. The primary endpoint was sufficient vertical R0 (SVR0) resection, defined as R0 resection with tumor-free vertical margin ≥500 μm.

RESULTS

Of 102 rectal NETs treated with ESMR-L, 71 were resected with injection and 31 without injection. Tumor-free vertical margin distance was significantly greater in ESMR-L without injection (1070 vs 430 μm, P < .001). ESMR-L without injection achieved a significantly higher SVR0 resection rate (67.7% vs 40.8%, P = .018) without an increase in adverse events.

CONCLUSIONS

ESMR-L without injection can be simpler and more effective for small rectal NETs than ESMR-L with injection.