A systematic review and meta-analysis of endoscopic mucosal resection <i>vs</i> endoscopic submucosal dissection for colorectal sessile/non-polypoid lesions
Endrit Shahini, Roberto Passera, Giacomo Lo Secco, Alberto Arezzo
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.