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KMID : 0338420240390020238
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The Korean Journal of Internal Medicine
2024 Volume.39 No. 2 p.238 ~ p.247
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Endoscopic mucosal resection using anchored snare Tip-in versus precut technique for small rectal neuroendocrine tumors
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Hong Seung-Wook
Yang Dong-Hoon
Lee Yoo-Jin
Baek Dong-Hoon
Chun Jae-Young
Kim Hyun-Gun
Kim Sung-Joo
Hong Seung-Mo
Myung Dae-Seong
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Abstract
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Background/Aims: Small rectal neuroendocrine tumors (NETs) can be treated with modified endoscopic mucosal resection (EMR). However, an optimal EMR method remains to be established. We aimed to assess the non-inferiority of Tip-in EMR versus precut EMR (EMR-P) for treating rectal NETs.
Methods: This prospective, multicenter, randomized controlled trial enrolled patients with rectal NETs of < 10 mm in diameInter.
The patients were randomly assigned to EMR-P and Tip-in EMR groups in a 1:1 ratio. Primary outcome was margin-negative (R0) resection rate between the two methods, with a noninferiority margin of 10%.
Results: Seventy-five NETs in 73 patients, including 64 eligible lesions (32 lesions in each, EMR-P and Tip-in EMR groups), were evaluated. In a modified intention-to-treat analysis, R0 resection rates of the EMR-P and Tip-in EMR groups were 96.9% and 90.6%, respectively, which did not demonstrate non-inferiority (risk difference, -6.3 [95% confidence interval: -18.0 to 5.5]). Resection time in the EMR-P group was longer than that in the Tip-in EMR group (p < 0.001). One case of intraprocedural bleeding was reported in each group.
Conclusions: We did not demonstrate the non-inferiority of Tip-in EMR compared to EMR-P for treating small rectal NETs.
However, the R0 resection rates for both techniques were high enough for clinical application.
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KEYWORD
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Endoscopic mucosal resection, Multicenter study, Neuroendocrine tumors, Randomized controlled trial
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