Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors: a meta-analysis

Abstract

Aim: To compare the efficacy and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for the treatment of colorectal tumors.

Methods: Databases, such as PubMed, EMBASE, Cochrane Library and Science Citation Index updated to 2013 were searched to include eligible articles. In the meta-analysis, the main outcome measurements were the en bloc resection rate, the histological resection rate and the local recurrence rate. Meanwhile, we also compared the operation time and the incidence of procedure-related complications.

Results: Six trials were identified and a total of 1642 lesions were included. The en bloc resection rate was higher and the local recurrence rate was lower in the ESD group compared with the EMR group (OR = 7.94; 95%CI: 3.96-15.91; OR = 0.09; 95%CI: 0.04-0.19). There was no significant difference in histological resection rate(OR = 1.65; 95%CI: 0.29-9.30) and procedure-related complication rate between the two groups (OR = 1.59; 95%CI: 0.92-2.73). The meta-analysis also showed that ESD was more time consuming than EMR.

Conclusion: Compared with EMR, ESD results in higher en bloc resection rate and lower local recurrence rate for the treatment of colorectal tumors, without increasing the procedure-related complications.

Keywords: Colorectal tumors; Complication; En bloc resection; Endoscopic mucosal resection; Endoscopic submucosal dissection; Histological resection; Local recurrence.

Figures

Figure 1

Flow diagram of trial selection.

Figure 2

Comparing endoscopic submucosal dissection and endoscopic mucosal resection. A: En bloc resection rate; B: Histological resection rate; C: Local recurrence rate; D: Procedural time; E: Procedure-related complications. ESD: Endoscopic submucosal dissection; EMR: Endoscopic mucosal resection.