Supplementary Material for: Clinical Value of clip-and-snare assisted endoscopic submucosal resection in Treatment of Rectal Neuroendocrine Tumors

Introduction: To introduce a new endoscopic technology, clip-and-snare assisted endoscopic submucosal resection (CS-ESMR) for treatment of rectal neuroendocrine tumors (NETs), and then to investigate the therapeutic value of CS-ESMR. Methods: In this retrospective study, 67 patients who underwent endoscopic treatment of rectal NETs from March 2017 to Dec 2021 were analyzed. According to the endoscopic resection methods (EMR, CS-ESMR and endoscopic submucosal dissection (ESD)), the cases were divided into CS-ESMR group (27 cases), ESD group (31 cases), and EMR group (9 cases). The pathological R0 resection rate and the incidence of adverse events (bleeding and perforation) were compared among the three groups. Results: There was a significant difference about the pathological R0 resection between the CS-ESMR group and the EMR group and between the CS-ESMR group and the ESD group(both P<0.05); Compared with ESD group, the procedure time, intraoperative bleeding and the cost of CS-ESMR group are significantly decreased (P<0.001, P<0.05, P<0.001, respectively). Conclusion: CS-ESMR may be a safe and effective treatment for rectal NETs with a diameter of less than 10mm, without muscularis propria invasion and metastasis.

引言：本研究旨在介绍一种用于治疗直肠神经内分泌肿瘤（rectal neuroendocrine tumors, NETs）的新型内镜技术——夹套联合圈套器辅助内镜黏膜下切除术（clip-and-snare assisted endoscopic submucosal resection, CS-ESMR），并探讨CS-ESMR的治疗价值。方法：本回顾性研究分析了2017年3月至2021年12月期间接受直肠神经内分泌肿瘤内镜治疗的67例患者。根据内镜切除方式（内镜黏膜切除术（endoscopic mucosal resection, EMR）、CS-ESMR及内镜黏膜下剥离术（endoscopic submucosal dissection, ESD）），将病例分为CS-ESMR组（27例）、ESD组（31例）及EMR组（9例）。比较三组患者的病理学R0切除率及不良事件（出血、穿孔）发生率。结果：CS-ESMR组与EMR组、CS-ESMR组与ESD组的病理学R0切除率均存在显著差异（均P<0.05）；与ESD组相比，CS-ESMR组的手术时长、术中出血量及治疗成本均显著降低（分别为P<0.001、P<0.05、P<0.001）。结论：对于直径小于10mm、未侵犯固有肌层且无转移的直肠神经内分泌肿瘤，CS-ESMR或许是一种安全有效的治疗方式。