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Video of Issue Gel immersion endoscopic mucosal resection for grade 1 rectal neuroendocrine tumors (carcinoid)
Natsuko Saitoorcid, Takeshi Yamashinaorcid, Masaaki Shimatani,orcid

DOI: https://doi.org/10.5946/ce.2024.064
Published online: September 6, 2024

Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Japan

Correspondence: Masaaki Shimatani Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan E-mail: shimatam@hirakata.kmu.ac.jp
• Received: April 2, 2024   • Revised: May 21, 2024   • Accepted: May 31, 2024

© 2024 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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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.
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.
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A video related to this article can be found online at https://doi.org/10.5946/ce.2024.064.
Fig. 1.
(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.
ce-2024-064f1.jpg
  • 1. Ito T, Masui T, Komoto I, et al. JNETS clinical practice guidelines for gastroenteropancreatic neuroendocrine neoplasms: diagnosis, treatment, and follow-up: a synopsis. J Gastroenterol 2021;56:1033–1044.ArticlePubMedPMCPDF
  • 2. Yamashina T, Tumura T, Maruo T, et al. Underwater endoscopic mucosal resection: a new endoscopic method for resection of rectal neuroendocrine tumor grade 1 (carcinoid) ≤ 10 mm in diameter. Endosc Int Open 2018;6:E111–E114.ArticlePubMedPMC
  • 3. Yamashina T, Shimatani M, Takahashi Y, et al. Gel immersion endoscopic mucosal resection (EMR) for superficial nonampullary duodenal epithelial tumors may reduce procedure time compared with underwater EMR (with video). Gastroenterol Res Pract 2022;2022:2040792.ArticlePubMedPMCPDF

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      Gel immersion endoscopic mucosal resection for grade 1 rectal neuroendocrine tumors (carcinoid)
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      Fig. 1. (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.

      Fig. 1.

      Gel immersion endoscopic mucosal resection for grade 1 rectal neuroendocrine tumors (carcinoid)
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