7098 Endoscopic mucosal resection of small rectal carcinoid tumors: usefulness of high-resolution double-channel video endoscope.

Background: Well-differentiated rectal carcinoids less than or equal to 1 cm are submucosal tumors suited to endoscopic mucosal resection (EMR); they can be cured by adequate local excision. Standard polypectomy using conventional type endoscopy, however, may not provide an optimal margin of resection,necessitating further intervention or surgery. We evaluated the safety and efficacy of EMR using high-resolution double-channel video endoscope for very small rectal carcinoid tumors less than 10 mm even though 0.5 mm. Subjects and Methods: From February 1996 to August 1999, a total of twenty-two rectal carcinoid tumors less than 10 mm in 14 patients was discovered during routine total colonoscopy using a high-resolution double channel video-endoscope (Fujinon EC-410Dcw). The double channel, one for picking up the tumor and another for snaring, was used all procedures. Submucosal saline injection was not utilized. Snare resection was carried out using a blended electrosurgical current. Results: Twenty-two typical rectal carcinoid tumors ranging in size 0.5 to 10 mm were treated. There were no immediate or late complications. Specimens were approximately 5 to 15 mm in diameter. Histopathological diagnoses revealed well-differentiated neuroendocrine tumor. Special stains were positive for chromogranin A, neuron-specific enolase and synaptophysin in all lesions. The endoscopic feature of small carcinoids was yellowish and swelling of normal pit pattern. None of the lesions were umbilicated or centrally ulcerated. There has been no local or distant recurrence with a follow-up of 0.2 to 3.6 years. Conclusions: This technique is ideally suited for small carcinoid tumors less than 1 cm in diameter.