目的:尽管内镜下切除直肠神经内分泌肿瘤(R-NENs)是一种有效的恶性潜能低的治疗方法,对于最推荐的内镜检查方法尚无共识.本研究旨在评估不同内镜治疗对低恶性潜能R-NENs的疗效和可接受性。
方法:我们在数据库中搜索了使用内窥镜切除治疗R-NEN的研究。这些研究包括内窥镜粘膜切除术(EMR)等技术,内镜黏膜下剥离术(ESD),改良内镜黏膜切除术(EMRM),改良内镜黏膜下剥离术(ESDM),经肛门内窥镜显微手术(TEM)。评估的主要结果是组织学完全切除(HCR)。
结果:总体而言,确定了38项回顾性研究(3040个R-NENs)。带帽内镜粘膜切除术(EMRC),内镜下黏膜结扎术(EMRL),ESD,ESDM,在实现HCR方面,TEM显示出比EMR更高的可切除性。内镜粘膜切除术,EMRC,EMRL,EMRP,EMRD,EMRU所需的操作时间比ESD短。内镜粘膜切除术,EMRC,ESDM,TEM的风险低于ESD。
结论:关于具有低恶性潜能的<20mm的R-NENs,ESD可以用作主要处理。然而,如果有经济条件和医院设施的支持,TEM可能会更有效。关于R-NENs<16mm,具有低恶性潜能,EMRL可以用作主要治疗。关于R-NENs<10mm,具有低恶性潜能,EMRL,EMRC,ESD可以作为主要治疗方法。然而,考虑到运营困难和经济状况,EMRL和EMRC可能会更好。
OBJECTIVE: Although endoscopic resection is an effective treatment of rectal neuroendocrine neoplasms (R-NENs) with low malignant potential, there is no consensus on the most recommended endoscopic method. This study aimed to assess the efficacy and acceptability of different endoscopic treatments for R-NENs with low malignant potential.
METHODS: We searched databases for studies on treatments of R-NENs using endoscopic resection. These studies comprised techniques such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), modified endoscopic mucosal resection (EMRM), modified endoscopic submucosal dissection (ESDM), and transanal endoscopic microsurgery (TEM). The primary outcomes assessed were histological complete resection (HCR).
RESULTS: Overall, 38 retrospective studies (3040 R-NENs) were identified. Endoscopic mucosal resection with a cap (EMRC), endoscopic mucosal resection with ligation (EMRL), ESD, ESDM, and TEM demonstrated higher resectability than did EMR in achieving HCR. Endoscopic mucosal resection, EMRC, EMRL, EMRP, EMRD, and EMRU required shorter operation times than did ESD. Endoscopic mucosal resection, EMRC, ESDM, and TEM incurred lower risks than did ESD.
CONCLUSIONS: Regarding R-NENs <20 mm with low malignant potential, ESD could be used as the primary treatment. However, TEM may be more effective if supported by economic conditions and hospital facility. With respect to R-NENs <16 mm with low malignant potential, EMRL could be used as the primary treatment. In regard to R-NENs <10 mm with low malignant potential, EMRL, EMRC, and ESD could be used as the primary treatment. However, EMRL and EMRC might be better when operational difficulties and economic conditions were considered.