Feasibility of salvage endoscopic mucosal resection by using a cap for remnant rectal carcinoids after primary EMR

Background: Secondary endoscopic treatment for remnant lesions of rectal carcinoid tumors after primary EMR or polypectomy is technically difficult because of fibrosis of residual tissues. EMR by using a cap (EMR-C), a method to resect the submucosal layer by suction by using a transparent cap, may be feasible as a salvage treatment. Objective: To assess the feasibility of salvage EMR-C. Design: Retrospective analysis. Setting: Tertiary academic health care system. Patients: Thirty-one patients who were referred for salvage treatment of a failed en bloc excision of rectal carcinoid tumors after primary EMR or polypectomy between January 2007 and December 2009. Interventions: Salvage EMR-C for remnant carcinoid tumors in the rectum. Main Outcome Measurements: Rate of complete resection, complications, length of procedure, and recurrence rate. Results: The mean age of the patients was 52.0 ± 11.8 years (range 3078 years). The mean tumor size was 8.9 ± 3.2 mm (range 5.013.0 mm). The mean procedure time was 9.1 ± 3.7 minutes, and clear resection margins were pathologically confirmed in all 31 patients. The most common complication of salvage EMR-C was bleeding (7 patients, 22.6%), which was successfully treated by hemoclipping in all cases. The 1-year follow-up colonoscopy and CT results for all patients were negative for recurrence. Limitations: Retrospective design and limited cases at a single center. Conclusions: EMR-C is a feasible salvage therapeutic option for failed en bloc excision after primary endoscopic treatment of rectal carcinoid tumors.