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Incidental diagnosis of very small rectal neuroendocrine neoplasms: when should endoscopic submucosal dissection be performed? A single ENETS centre experience

  • Nico Pagano
  • Claudio Ricci
  • Nicole Brighi
  • Carlo Ingaldi
  • Francesco Pugliese
  • Donatella Santini
  • Davide Campana
  • Cristina Mosconi
  • Valentina Ambrosini
  • Riccardo CasadeiEmail author
Original Article



The management of small (≤5 mm) rectal neuroendocrine neoplasms (r-NENs), incidentally removed during colonoscopy, still remains under debate.


All consecutive patients affected by r-NENs from January 2013 to December 2017 were studied. The inclusion criteria were: (1) patients having an incidental pathological diagnosis of very small (≤5 mm) polypoid r-NENs; (2) patients treated with a standard polypectomy as first-line therapy and (3) patients treated by endoscopic submucosal dissection (ESD) as salvage therapy. The primary endpoint was to identify the factors related to residual disease after a standard polypectomy. The secondary endpoint was to calculate the accuracy of endoscopic ultrasound (EUS), grading and size in predicting residual disease.


Starting from a prospective database of 123 consecutive patients affected by r-NENs, only 31 met the inclusion criteria. A final pathological examination of an ESD specimen showed residual disease in 7 out of 31 patients (22.6%). A multivariate analysis showed that the size of the polyps was the only independent factor related to residual disease with an odds ratio of 8.7 ± 7.5 (P = 0.013) for each millimetre. The accuracy of EUS, grading and tumour size (3.1 mm cut-off point) and area under the curves were 0.661 ± 0.111, 0.631 ± 0.109 and 0.821 ± 0.109, respectively.


When the r-NEN polyp was larger than 3 mm, ESD was indicated. Unlike the size of the tumour, grading and EUS features did not accurately predict residual disease.


Rectal endocrine neoplasm Endoscopy Endoscopic submucosal dissection Endoscopic mucosal dissection 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

12020_2019_1907_MOESM1_ESM.docx (13 kb)
Supplementary Information
12020_2019_1907_MOESM2_ESM.docx (14 kb)
Supplementary table1
12020_2019_1907_MOESM3_ESM.pdf (176 kb)
Supplementary figure


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Nico Pagano
    • 1
  • Claudio Ricci
    • 1
  • Nicole Brighi
    • 2
  • Carlo Ingaldi
    • 1
  • Francesco Pugliese
    • 3
  • Donatella Santini
    • 4
  • Davide Campana
    • 1
  • Cristina Mosconi
    • 2
  • Valentina Ambrosini
    • 2
  • Riccardo Casadei
    • 1
    Email author
  1. 1.Department of Internal Medicine and Surgery (DIMEC)Alma Mater Studiorum-Università di BolognaBolognaItaly
  2. 2.Department of Specialized Diagnostic and Experimental Medicine (DIMES)Alma Mater Studiorum-Università di BolognaBolognaItaly
  3. 3.Endoscopic UnitASST Niguarda-Ca’ Granda HospitalMilanItaly
  4. 4.Histopathological Unit, Department of Diagnostic and Preventive MedicinePoliclinico S. Orsola-MalpighiBolognaItaly

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