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

Abstract Background Multiple endoscopic treatment options are available for rectal neuroendocrine tumors (NETs), with conventional endoscopic submucosal dissection (c-ESD) being the most commonly used method. However, there are certain challenges in the use of c-ESD to treat rectal NETs. To address these issues, pretraction-assisted ESD (p-ESD) was developed. This study aimed to compare the efficacy and safety of p-ESD and c-ESD for the treatment of rectal NETs. Methods This retrospective observational study included consecutive patients with rectal NETs measuring less than 15 mm in size who underwent p-ESD or c-ESD at Fujian Medical University Union Hospital between January 2019 and December 2023. This study aimed to evaluate the differences in the dissection time, en bloc resection rate, R0 resection rate, and adverse event rate between the p-ESD and c-ESD groups. Results A total of 103 patients were included in the study, with 49 in the p-ESD group and 54 in the c-ESD group. The dissection time in the p-ESD group was significantly shorter than that in the c-ESD group (median 9.3 vs. 14.9 min, P < 0.001). Additionally, the p-ESD group required no further injections after the first injection, whereas the c-ESD group required significantly more injections (0 vs. 1.54 ± 0.57 injections, P < 0.001). Furthermore, there were no significant differences in en bloc resection rates between the groups. The R0 resection rate was notably greater in the p-ESD group (49/49 patients, 100% vs. 48/54 patients, 88.9%, P = 0.028). The p-ESD group also had a lower rate of intraoperative bleeding (2/49, 4.1% vs. 10/54, 18.5%, P = 0.048). No significant differences in other adverse events were found. Conclusions This study demonstrated that p-ESD for rectal NETs is both effective and safe, reducing procedure complexity while ensuring a high R0 resection rate. p-ESD also reduces the dissection time and decreases the incidence of intraoperative bleeding.