A systematic review and meta-analysis of endoscopic mucosal resection vs endoscopic submucosal dissection for colorectal sessile/non-polypoid lesions. Issue 6 (1st August 2022)

• Record Type: Journal Article
• Authors: Shahini, Endrit; Passera, Roberto; Lo Secco, Giacomo; Arezzo, Alberto
• Is Part Of: Minimally invasive therapy & allied technologies. Volume 31:Issue 6(2022)
• Page Start: 835
• Page End: 847
• Publication Date: 2022-08-01
• Subjects: Colorectal cancer -- adenoma detection -- C-EMR -- U-EMR -- ESD; Endoscopy -- Periodicals; Interventional radiology -- Periodicals; Endoscopic surgery -- Periodicals; 617.05
• DOI: 10.1080/13645706.2022.2032759
• Languages: English
• ISSNs: 1364-5706

Abstract

Abstract: Background: Current international guidelines strongly advise endoscopic submucosal dissection (ESD) instead of endoscopic mucosal resection (EMR) for the endoscopic resection of sessile colorectal tumours >20 mm. Aims: To compare the safety and efficacy of EMR and ESD for treating large non-invasive colorectal lesions. Material and methods: We performed a systematic review using electronic databases (MEDLINE/PubMed, EMBASE, and Cochrane Library) on February 21st, 2021 and a meta-analysis to assess en-bloc and R0 rates, and related adverse events. Results: Twenty-four studies were included, comparing 3, 424 ESD and 5, 122 EMR procedures. The en-bloc resection rate was 90.8% in the ESD and 33.0% in the EMR group ( p < .001). The R0 resection rate was 85.0% in the ESD and 64.6% in the EMR group ( p = .005). The rate of perforation was 5.1% in the ESD and 1.67% in the EMR group ( p < .001). The bleeding rate was 4.3% in the ESD and 3.6% in the EMR group ( p = .008). The overall need for surgery, including oncologic reasons and complications, was 5.9% in the ESD and 3.1% in the EMR group ( p < .001). Conclusions: ESD for large non-pedunculated colorectal lesions allows a higher rate of R0 resections than EMR, at the cost of a higher perforation rate and the need for additional surgery.