To evaluate the efficacy and prognosis of endoscopic submucosal resection with ligation (ESMR-L) and endoscopic submucosal dissection (ESD) for the treatment of G1 rectal neuroendocrine tumors (R-NETs).

In this case- control study, 108 patients with G1 stage R-NETs treated endoscopically in endoscopy Department of Northern Theater Command General Hospital from December 2021 to December 2023 wereselected, and were divided into 63 cases in the ESD group and 45 cases in the ESMR-L group according to the different treatment modalities.The hospitalization time, hospitalization cost, operation time, tumor length, tumor depth, and postoperative endoscopic complete resection rate, histopathological complete resection rate, intraoperative perforation, and postoperative delayed hemorrhage rate were compared between the two groups.Binary logistic regression analysiswas performed based on postoperative histopathologic complete resection.

The endoscopic complete resection rates were 98.41% and 95.56%, the histopathologic complete resection rates were 93.65% and 82.22%, and the postoperative delayed hemorrhage rates were 4.76% and 0 in the ESD and ESMR-L groups, respectively.The difference was not statistically significant(P>0.05). Intraoperative perforation rates were 1.59% and 11.11%, respectively, but no infection occurred after intraoperative closure by titanium clips, and the difference was statistically significant(P<0.05). There were no cases of postoperative perforation and tumor recurrence in either group.Compared with the ESD group, the ESMR-L group had shorter hospitalization time, hospitalization cost, and operation time (P<0.001). Binary logistic regression analysis showed that tumor length ≥7 mm and tumor depth to the submucosal layer were risk factors affecting the histopathological complete resection rate and patient prognosis.

Endoscopic resection of R-NETs is safe and effective, but a comprehensive preoperative assessment based on tumor length and infiltration depth is needed.For G1-stageR-NETs with a shallow tumor depth and a diameter of < 7 mm, S-ESMR-L is a more economical and effective treatment option T-than ESD.