Underwater endoscopic mucosal resection for rectal neuroendocrine tumors (with videos): a single center retrospective study.

BACKGROUND: Underwater endoscopic mucosal resection (UMER) is a new method of endoscopic resection to completely remove the lesion without submucosal injection. But few attempts have been carried out for rectal neuroendocrine tumors (rectal NETs). METHODS: We retrospectively investigated data on the tumor characteristics and outcomes of patients with ≤ 10 mm rectal NETs who underwent UEMR or endoscopic submucosal dissection (ESD) from January 2019 to June 2021 in our institute. RESULTS: The endoscopic resection rate was 100% in both UEMR and ESD groups. The histological complete resection rate of the UEMR group (95.5%) was lower than that of the ESD group (96.4%) with no significant difference. The average operation time, hospitalization time and operation cost of UEMR group were less than those of ESD group (P < 0.05). The incidence of postoperative abdominal pain and abdominal distention in the UEMR group was lower than that in the ESD group (P < 0.05). There was no significant difference in the incidence of delayed bleeding and perforation between the two groups. There was no local recurrence or distant metastasis in the two groups during the follow-up period. CONCLUSIONS: Both the UEMR and ESD can effectively treat ≤ 10 mm rectal NETs with invasion depth confined to the mucosa and submucosa. UEMR is superior to ESD in operation time, hospitalization time, operation cost, postoperative abdominal pain and abdominal distention.

Tumor rectal como presentación de sífilis primaria: presentación de caso / A rectal tumor as primary syphilis presentation: a study case

Se presenta el caso de un paciente masculino de 65 años, que acude a la guardia refiriendo dolor anal reciente. Al examen físico presenta una fisura anal crónica en la comisura posterior y al tacto rectal se palpa una masa ubicada sobre el anillo anorectal. La video colonoscopía identifica una lesión de aspecto neoplásico. La biopsia señala inflamación crónica leve. La resonancia magnética pelviana informa compromiso tumoral infiltrativo transmural del recto inferior. La biopsia de la zona evidencia espiroquetas. La serología es positiva para sífilis (+ Sífilis). Luego del tratamiento indicado el paciente evoluciona satisfactoriamente.

A 65 years old male patient appeared at the emergency service referring recent anal pain. The physical examination shows a chronic anal fissure in the posterior corner and the rectal examination shows a mass on the anorectal ring. Video colonoscopy identifies a lesion with a neoplasic aspect. The biopsy shows mild chronic inflammation. The MRI of the pelvis informs transmural infiltrative tumoral compromise of the lower rectum. The biopsy of the area presents spirochetes. Serology is positive for syphilis (+ Syphilis). After the indicated treatment, the patient evolves satisfactorily.

Transposterior approach for local excision of mid-low rectal stromal tumor / 中华消化外科杂志

In spite of the fact that rectal stromal tumor accounts for only 4.2％ of the gastrointestinal stromal tumor,its surgical treatment is still very difficult and challenging due to the special anatomical position of rectum,its complicated anatomical relationship with adjacent organs,and whether the anus be preserved.Local resection of rectal stromal tumor is feasible and reasonable owing to its biological characteristics.However,there are many approaches and methods for local resection and no consensus has been reached.The clinical data of 18 patients with rectal stromal tumor who were treated by local resection via transposterior approach at the Peking Union Hospital from March 2003 to September 2012 were retrospectively analyzed.The surgery not only applies with the oncology treatment principle,but also preserves anus and limits the surgical injury to a large extent.Therefore,it is one of the most ideal surgical methods for the treatment of rectal stromal tumor.

Diagnosis and treatment of rectal stromal tumor / 中华消化外科杂志

Gastrointestinal stromal tumor (GIST) is a group of tumors which is independently derived from the mesenchymal stem cells of the digestive tract,and consists of undifferentiated or multi-functional spindle or epithelioid cells.Most of the rectal stromal tumor located at the middle or lower part of the rectum,and presented with exogenous growth outside of the rectum cavity.Rectal stromal tumor accounted for 5％ of GIST.Rectal stromal tumor is easily missed or misdiagnosed because of insidious onset and non-typical clinical manifestations.The diagnosis of rectal stromal tumor relies on immunohistochemical staining (CD117 and CD34) and pathological examination.Surgical resection is the first choice for the treatment of local primary rectal stromal tumor.Protection of the integrity of the tumor is important during operation,and routine lymph node dissection is not recommended.Molecular targeted drug mesylate imatinib is adopted in the pre-and postoperative adjuvant therapy.However,due to the rarity of rectal stromal tumor,the treatment strategies need further investigation.