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Meta-Analysis
. 2021 Oct;35(10):5422-5429.
doi: 10.1007/s00464-021-08574-z. Epub 2021 Jun 2.

Endoscopic techniques to reduce recurrence rates after colorectal EMR: systematic review and meta-analysis

Gijs Kemper  1 , Ayla S Turan  2 , Erik J Schoon  3 , Ruud W M Schrauwen  4 , Ludger S M Epping  5 , Christian Gerges  6 , Torsten Beyna  6 , Horst Neuhaus  6 , Ufuk Gündug  7 , Peter D Siersema  2 , Erwin J M van Geenen  2 ; ENDOCARE Study Group
Affiliations
Meta-Analysis

Endoscopic techniques to reduce recurrence rates after colorectal EMR: systematic review and meta-analysis

Gijs Kemper et al. Surg Endosc. 2021 Oct.

Abstract

Background: Colorectal endoscopic mucosal resection (EMR) is an effective, safe, and minimally invasive treatment for large lateral spreading and sessile polyps. The reported high recurrence rate of approximately 20% is however one of the major drawbacks. Several endoscopic interventions have been suggested to reduce recurrence rates. We conducted a systematic review and meta-analysis to assess the efficacy of endoscopic interventions targeting the EMR margin to reduce recurrence rates.

Methods: We searched in PubMed and Ovid for studies comparing recurrence rates after interventions targeting the EMR margin with standard EMR. The primary outcome was the recurrence rate at the first surveillance colonoscopy (SC1) assessed histologically or macroscopically. For the meta-analysis, risk ratios (RRs) were calculated and pooled using a random effects model. The secondary outcome was post-procedural complication rates.

Results: Six studies with a total of 1335 lesions were included in the meta-analysis. The techniques performed in the intervention group targeting the resection margin were argon plasma coagulation, snare tip soft coagulation, extended EMR, and precutting EMR. The interventions reduced the adenoma recurrence rate with more than 50%, resulting in a pooled RR of 0.37 (95% CI 0.18, 0.76) comparing the intervention group with the control groups. Overall post-procedural complication rates did not increase significantly in the intervention arm (RR 1.30; 95% CI 0.65, 2.58).

Conclusion: Interventions targeting the EMR margin decrease recurrence rates and may not result in more complications.

Keywords: Colonic polyps; Endoscopic mucosal resection; Local neoplasm recurrence.

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Figures

Fig. 1
Fig. 1
Flow diagram of the selection process
Fig. 2
Fig. 2
Funnel plot of the included studies. RR risk ratio, SE standard error
Fig. 3
Fig. 3
Forest plot of the pooled and individual risk ratios for recurrence in the intervention groups versus groups receiving standard EMR. EMR endoscopic mucosal resection, CI confidence interval
Fig. 4
Fig. 4
Forest plot of the pooled and individual risk ratios for post-procedural complications in the intervention groups versus groups receiving standard EMR. EMR endoscopic mucosal resection, CI confidence interval
See this image and copyright information in PMC

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