To compare the efficiency and safety between ligation-assisted endoscopic submucosal resection (ESMR-L) without submucosa injection and endoscopic submucosal dissection (ESD) in resecting rectal neuroendocrine neoplasm with a diameter no more than 10 mm.

From January 2023 to April 2025, a prospective randomized controlled study was conducted at the Digestive Disease Hospital of Heilongjiang Provincial Hospital.Patients admitted to our department for endoscopic resection of rectal neuroendocrine tumors (with a diameter ≤10 mm, single lesion) were enrolled.Using a random number table, patients were evenly divided into the ESMR-L group and the ESD group in a 1∶1 ratio.All procedures were performed by senior endoscopists, and the procedure-related outcomes were compared between the two groups.

A total of 81 cases were included in the analysis, including 40 in the ESMR-L group and 41 in the ESD group.Postoperative pathology confirmed that the lesion was limited to the mucosal layer and submucosal layer, without lymphatic vascular invasion, and all were grade G1.The complete resection rate in both groups was 100%.The horizontal margins were negative, but 14 cases in the ESD group and 3 cases in the ESMR-L group had lesions close to the vertical margins (34.15% vs. 7.50%, P=0.004). The ESMR-L group had a shorter operation time than the ESD group (24 minutes vs. 39 minutes, P<0.001) and lower operation cost than the ESD group (3 760 RMB vs. 7 070 RMB, P<0.001). No complications or recurrence of lesions were observed in the two groups during the follow-up period (median 11 months).

For RNET with a diameter ≤10 mm, the efficacy and safety of the two resection methods are comparable, while ESMR-L without submucosa injection can improve the resection efficiency, significantly shorten the operation time and lower the cost.