Comparison of endoscopic submucosal dissection and transanal endoscopic microsurgery for T1 rectal neuroendocrine tumors: a propensity score-matched study

Background and Aims Endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) are the most effective endoscopic resection methods for T1 rectal neuroendocrine tumors (NETs). We aimed to compare the efficacy and safety of ESD and TEM for rectal NETs sized ≤20 mm. Methods Patients with rectal NETs (size ≤20 mm) who underwent ESD or TEM were enrolled in this retrospective observational study. ESD and TEM groups were matched for pathologic tumor size and endoscopic mucosal resection (EMR) history. We evaluated between-group differences in R0 resection rate, adverse event rate, procedure time, and hospital stay. Results We included 285 patients (ESD=226, TEM=59) in the final cohort, with 104 patients in the matched groups (ESD=52, TEM=52). The R0 resection rate was significantly higher for TEM (ESD 71.2% vs TEM 92.3%, p=0.005). However, the median procedure time [ESD 22 (range, 11-65) vs TEM 35 (17-160) mins, p Conclusions Although TEM showed a better overall R0 resection rate for rectal NETs ≤20 mm, ESD could be a viable treatment modality concerning adverse events, procedure time, and hospital stay for rectal NETs