Gel immersion endoscopic mucosal resection for a grade 1 rectal neuroendocrine tumor (carcinoid)
Article information
Endoscopic treatment is currently the standard treatment for grade 1 neuroendocrine tumors (NETs G1), including those in the rectum, with diameters not exceeding 10 mm.1 Several recent reports have indicated the utility of underwater endoscopic mucosal resection (EMR), which is less costly and requires a shorter procedural time.2 However, it can be difficult for water to accumulate during the procedure, and intestinal fluid and blood can mix with the water, worsening the visual field. Gel products were recently introduced and have been reported to be effective when used as an alternative to water for EMR.3 The most significant benefit of gel products is that they do not mix with intestinal fluid or blood because of their viscoelasticity and remain at the injection site, allowing visualization of the gastrointestinal tract. In this study, we report a case of endoscopic resection of a rectal NET G1 in which gel immersion (VISCOCLEAR; Otsuka Pharmaceutical Factory) EMR was useful.
The patient was a 65-year-old male diagnosed with an 8 mm NET G1 in the lower rectum on preoperative endoscopic biopsy. We attempted underwater EMR, but the visual field was compromised because of air inflow and turbidity caused by intestinal fluid, making the procedure difficult. The intestinal tract was filled with 150 mL of gel, air, and intestinal fluid, and the lesion floated smoothly, after which it was successfully resected en bloc using a bipolar snare (DRAGONARE; Xemex). Although spurting bleeding was observed from the ulcer immediately after resection, the blood did not spread into the gel, and the field of view remained clear, allowing the hemostatic procedure to be performed more safely and reliably (Fig. 1, Video 1). No postoperative adverse events have been observed at the time of writing, and histopathological findings were negative for both the vertical and horizontal sections.
(A) Underwater endoscopic view of the grade 1 neuroendocrine tumors. (B) Poor endoscopic view due to the accumulation of water and a mixture of air bubbles or intestinal fluids. (C) The gel easily prevented the formation of air bubbles and did not mix with the intestinal fluids, resulting in a good field of view and facilitating snaring. (D) Spurting bleeding did not spread into the gel, and the field of view remained clear.
Video
Video 1. Gel immersion endoscopic mucosal resection provided a good field of view and facilitated snaring. In addition, pulsatile bleeding after resection could be safely controlled.
A video related to this article can be found online at https://doi.org/10.5946/ce.2024.064.
Notes
Conflicts of Interest
The authors have no potential conflicts of interest.
Funding
None.
Author Contributions
Conceptualization: MS; Data curation: NS, TY; Writing–original draft: NS; Writing–review & editing: all authors.