Endoscopic submucosal dissection versus endoscopic mucosal resection for rectal carcinoid tumor. A meta‐analysis and meta‐regression with single‐arm analysis. Issue 10 (17th October 2021)

• Record Type: Journal Article
• Authors: Yong, Jie Ning; Lim, Xiong Chang; Nistala, Kameswara Rishi Yeshayahu; Lim, Lincoln Kai En; Lim, Grace En Hui; Quek, Jingxuan; Tham, Hui Yu; Wong, Neng Wei; Tan, Ker‐Kan; Chong, Choon Seng
• Is Part Of: Journal of digestive diseases. Volume 22:Issue 10(2021)
• Page Start: 562
• Page End: 571
• Publication Date: 2021-10-17
• Subjects: endoscopic mucosal resection -- endoscopic submucosal dissection -- meta‐analysis -- rectal carcinoid neoplasms; Digestive organs -- Diseases -- Periodicals; Gastroenterology -- Periodicals; 616.3
• DOI: 10.1111/1751-2980.13048
• Languages: English
• ISSNs: 1751-2972

Abstract

Abstract : Objective: As there has been so far no consensus on the best endoscopic resection technique, a meta‐analysis was conducted to compare the efficacy and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for treating rectal carcinoid tumors. Methods: MEDLINE and EMBASE databases were searched for articles on the treatment of rectal carcinoid tumors using ESD vs EMR published up to October 2020 for outcomes including en bloc and complete resection, margin involvement, procedure time, requirement for additional surgery, bleeding, perforation and recurrence. Risk ratio and weighted mean differences were used for a DerSimonian and Laird random effects pairwise meta‐analysis. Single‐arm meta‐analyses of proportions and random effects meta‐regression analysis were also conducted. Results: Twenty‐two studies involving 1360 rectal carcinoid tumors were included, in which 655 and 705 rectal carcinoid tumors were resected with ESD and EMR, respectively. The resection efficacy of ESD was comparable to that of EMR for tumors <10 mm. However, there were a significantly higher complete resection rate, and lower rates of vertical margin involvement and requirement for additional surgery using ESD than using EMR for tumors ≤20 mm. ESD had a longer procedure time and an increased likelihood of bleeding than EMR. Conclusions: ESD is more effective in providing a curative treatment for rectal carcinoid tumors ≤20 mm in size as ESD can achieve a higher complete resection rate with lower vertical margin involvement than EMR. While they are suitable for treating rectal carcinoid tumors <10 mm as both techniques provide similar efficacy. Abstract : Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are two common procedures for resecting rectal carcinoid tumors but there is currently no consensus on the optimal endoscopic resection technique. This meta‐analysis concludes that for rectal carcinoid tumors ≤10 mm, both ESD and EMR have similar curative efficacy, whereas for rectal carcinoid tumors of 10‐20 mm ESD is more effective. Complete resection rate; vertical margin involvement