Current status of endoscopic resection for small rectal neuroendocrine tumors.

Rectal neuroendocrine tumor (rNET) is an indolent malignancy often detected during colonoscopy screening. The incidence of rNET has increased approximately 10-fold over the past 30 years. Most rNETs detected during screening endoscopy are small, measuring < 10 mm. Current guidelines recommend endoscopic resection for small, well-differentiated rNET using modified endoscopic submucosal resection (mEMR) or endoscopic submucosal dissection. However, the optimal endoscopic treatment method remains uncertain. This paper summarizes the evidence on mEMR with submucosal stretching, mEMR without submucosal stretching, endoscopic submucosal dissection and endoscopic full-thickness resection. Given that rNETs often exhibit submucosal invasion, achieving adequate resection depth is crucial to ensure histological complete resection. mEMR with submucosal stretching appears favorable due to its high rate of histological complete resection, safety and convenience. Risk factors associated with lymph node and distant metastases are also discussed. A treatment algorithm is proposed to facilitate clinical decision-making.