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Meta-Analysis
. 2021 Jul 7;27(25):3925-3939.
doi: 10.3748/wjg.v27.i25.3925.

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

Xiong Chang Lim  1 , Kameswara Rishi Yeshayahu Nistala  1 , Cheng Han Ng  1 , Snow Yunni Lin  1 , Darren Jun Hao Tan  1 , Khek-Yu Ho  2 , Choon-Seng Chong  3 , Mark Muthiah  4
Affiliations
Meta-Analysis

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

Xiong Chang Lim et al. World J Gastroenterol. .

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.

Keywords: Colonic polyps; Colonoscopy; Colorectal neoplasm; Endoscopic mucosal resection; Endoscopy.

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Conflict of interest statement

Conflict-of-interest statement: The authors deny any conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of included articles. ESD: Endoscopic submucosal dissection; EMR: Endoscopic mucosal resection.
Figure 2
Figure 2
Forest plot for risk of perforation. RR: Relative risk; CI: Confidence interval.
Figure 3
Figure 3
Forest plot for risk of bleeding. RR: Relative risk; CI: Confidence interval.
Figure 4
Figure 4
Forest plot for recurrence rate. RR: Relative risk; CI: Confidence interval.
Figure 5
Figure 5
Meta regression of perforation and proportion of right colon polyps. CI: Confidence interval.
See this image and copyright information in PMC

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