Analysis of endoscopic salvage treatment of rectal neuroendocrine tumor; effective utilization of polypectomy

Abstract Background Current guidelines recommend endoscopic resection for rectal neuroendocrine tumors (RNETs) under 10 mm. Incomplete resections necessitate salvage procedures, highlighting the need for complete R0 resection. This study assesses the efficacy and safety of wide hot snare polypectomy (WHSP) compared to endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for treating small RNETs. Methods This retrospective study was conducted at Korea University Guro Hospital from January 2018 to December 2022. It compared the outcomes of salvage resections for RNETs ≤ 10 mm using two approaches: endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) versus WHSP. Demographics, tumor characteristics, and clinical outcomes were compared. Efficacy was evaluated by the histological complete resection rate and procedure time, while safety was assessed by the incidence of complications. Results Out of 135 patients undergoing salvage resection for RNET, 14 who underwent transanal excision were excluded. Of the remaining 121, 99 underwent EMR or ESD, and 22 underwent WHSP. Baseline characteristics were similar between the two groups. The WHSP group demonstrated a significantly higher R0 resection rate (72.7% vs. 49.5%, p = 0.010) and a shorter median procedure time (3.5 min vs. 8.3 min). No complications were reported in the WHSP group. Conclusion Wide hot snare polypectomy is a rapid, straightforward, safe, and effective approach for the salvage treatment of rectal neuroendocrine tumors (RNETs) less than 10 mm in diameter, particularly in patients without additional risk factors.