['Various methods for complete endoscopic resection of rectal carcinoid tumors have been reported; however, the number of cases investigated in each study has been limited. The aim of the present study was to clarify the clinical usefulness of a novel technique named endoscopic submucosal resection with a ligation device (ESMR-L) in a large number of rectal carcinoid tumors.', 'Between January 1999 and March 2005, a total of 61 patients with 63 rectal carcinoid tumors estimated at 10 mm or less in diameter, without atypical features and resected by ESMR-L were recruited for this analysis. The complete resection rate, complications associated with the procedure, local recurrence, and distant metastases were evaluated.', 'Sixty-one patients were 36 males and 25 females with a mean age of 59 +/- 11 years (24-76 years). Tumor size ranged from 2 to 12 mm in diameter, with an average size of 6.4 +/- 2.4 mm. Fifty-nine lesions (93.6%) were located in the lower rectum (Rb), three in the upper rectum (Ra) and one in the recto-sigmoid colon (Rs). In total, 60 out of 63 lesions (95.2%) were histologically determined to be completely resected. The complete resection rate for lesions located in the Rb was 98.3%, which was significantly higher than that for lesions in Ra and Rs (50%). Minor bleeding associated with the procedure occurred in five lesions (7.9%), but all cases were successfully managed with hemoclips. Histopathologically, all tumors were located in the submucosal layer, and all were classified as classical-type carcinoids without lymphovascular invasion. Neither local recurrence nor distant metastasis was detected during a median follow-up period of 24 months.'] Is endoscopic submucosal resection with a ligation device an effective and safe treatment for carcinoid tumors in the lower rectum?