Efficacy and safety of pretraction-assisted endoscopic submucosal dissection for treating rectal neuroendocrine tumors.

Background: Conventional endoscopic submucosal dissection (c-ESD) is a widely used technique for rectal neuroendocrine tumors (NETs), but it poses certain challenges. To address these, we developed a pretraction-assisted endoscopic submucosal dissection (p-ESD) technique.

Aim: To compare the efficacy and safety of p-ESD and c-ESD for rectal NETs.

Methods: This retrospective study included consecutive patients with rectal NETs measuring less than 15 mm who underwent either pESD or cESD at Fujian Medical University Union Hospital between January 2019 and December 2023. The study aimed to evaluate differences in dissection time, en bloc resection rate, R0 resection rate, and adverse event rates between the pESD and cESD groups.

Results: In total, 103 patients were enrolled (49 in the p-ESD group and 54 in the c-ESD group). The p-ESD group exhibited a significantly shorter median dissection time (9.3 minutes vs 14.9 minutes; P < 0.001) and a higher R0 resection rate (100% vs 88.9%; P = 0.028), while en bloc resection rates were comparable. Rates of minor intraoperative bleeding (10.2% vs 25.9%; P = 0.040) and major intraoperative bleeding (4.1% vs 18.5%; P = 0.030) were lower in the p-ESD group. No muscularis propria injuries occurred in the p-ESD group vs 16.7% in the c-ESD group (P = 0.003). Other adverse events did not differ significantly.

Conclusion: p-ESD is safe and effective for treating rectal NETs. Compared with c-ESD, it is technically easier, requires less dissection time, achieves higher R0 resection rates, reduces intraoperative bleeding, and lowers the risk of muscularis propria injury.