Factors Influencing Resection Time in Endoscopic Submucosal Dissection for Rectal Neuroendocrine Tumors.

Objectives: The usefulness of endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors (NETs) is well established. However, factors influencing resection time remain unclear. This study aimed to identify these factors during ESD for rectal NETs.

Methods: This retrospective study included 194 rectal NET lesions that were treated with ESD at our institution between March 2011 and July 2024. Potential factors influencing resection time-including age, sex, operator experience (non-expert endoscopist: <50 colorectal ESD cases), sodium hyaluronate use, traction device (TD) use, tumor location, lesion size, and specimen area-were analyzed using multiple regression analysis.

Results: The median resection time was 30 min (interquartile range [IQR]: 20-43 min). Non-expert endoscopists performed 53% of the procedures. The median specimen area was 302 mm (IQR: 233-393 mm). Resection time was significantly longer when procedures were performed by non-experts (β = 8.66; 95% confidence interval [CI]: 4.46-12.86; <0.001), when the tumor was located in the upper rectum (Rs) compared to the lower rectum (Rb) (β = 20.96; 95% CI: 7.82-34.1; = 0.002), and with increasing specimen area (β = 0.04; 95% CI: 0.027-0.06; <0.001). Conversely, TD use significantly shortened resection time (β = -5.90; 95% CI: -11.37 to -0.43; = 0.036).

Conclusions: Traction device use during ESD for rectal NETs is associated with shorter resection time; whereas, procedures performed by non-experts, tumors located in the Rs, and larger specimen areas were associated with longer resection time.