Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal polyps: A meta-analysis and meta-regression with single arm analysis

Abstract

BACKGROUND Endoscopic submucosal dissection (ESD) has shown to be effective in management of colorectal neoplasm in the Asian countries, while its implementation in Western countries where endoscopic mucosal resection (EMR) is preferred is still debatable. AIM To compare the surgical, histological, and oncological outcomes between ESD and EMR in the treatment of colorectal polyps, with subgroup analysis comparing the efficacy of ESD and EMR between Japan and the rest of the world. METHODS Embase and Medline databases were searched from inception to October 2020 in accordance with PRISMA guidelines for studies comparing en bloc , complete resection, margin involvement, resection time, need for additional surgery, complications, and recurrence rate of ESD with EMR. RESULTS Of 281344 colorectal polyps from 21 studies were included. When compared to EMR, the pooled analysis revealed ESD was associated with higher en bloc and complete resection rate, and lower lateral margin involvement and recurrence. ESD led to increased procedural time, need for additional surgery, and perforation risk. No significant difference in bleeding risk was found between the two groups. Meta-regression analysis suggested only right colonic polyps correlated with an increased perforation risk in ESD. Confounders including polyp size and invasion depth did not significantly influence the en bloc and complete resection rate, bleeding risk and recurrence. In subgroup analysis, Japan performed better than the rest of the world in both ESD and EMR with perforation risk of 4% and 0.0002%, respectively, as compared to perforation risk of 8% and 1%, respectively, in reports coming from rest of the world. CONCLUSION ESD resulted in better resection outcomes and lower recurrence compared to EMR. With appropriate training, ESD is preferred over EMR as the first-line therapy for resection of colorectal polyps, without restricting to lesions greater than 20 mm and those with high suspicion of submucosal invasion.

Recurrence rates after endoscopic resection of large colorectal polyps: A systematic review and meta-analysis

“…When standard EMR without routine margin ablation is used, we found a 12-month recurrence rate of 15.2%. This is comparable to the results found in the two available meta-analyses published in 2014 and 2021, which reported recurrence rates of 15%[ 6 ] and 10%[ 23 ], respectively. However, since then, many new or modified endoscopic removal techniques have been developed.…”

Safety of endoscopic mucosal resection of large colonic polyps in elderly patients: a systematic review and meta-analysis

“…A piecemeal technique was utilized in 20 of 22 patients who had residual polypoid tissue. ESD is associated with a lower rate of recurrence as compared to EMR, but ESD is a labor-intensive and technically difficult procedure associated with a higher perforation rate [ 39 ].…”

Clinical analysis of metastatic characteristics of infrapyloric lymph nodes (No.206) and terminal ileum lymph nodes in patients with right colon cancer

“…The vascular anatomy of the right colon has showed several significant changes, including the absence of some branches (lack of RCA in 27.4% of cases), extra branches, common trunk, and posterior superior mesenteric vein routes [ 33 ]. Therefore, most studies indicate that the proximal ileum resection margin for right colon cancer should be 5–10 cm from the tumor margin [ 34 ]. In this study, we have demonstrated that terminal ileum lymph node metastasis is related to tumor location ( χ 2 = 6.273, p = 0.043).…”