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Meta-Analysis
. 2025 Mar 13:80:100613.
doi: 10.1016/j.clinsp.2025.100613. eCollection 2025.

Comparison of endoscopic submucosal dissection and transanal endoscopic surgery for the treatment of rectal neoplasia: A systematic review and meta-analysis

Igor Valdeir Gomes de Sousa  1 , Alexandre Moraes Bestetti  2 , Diego Paul Cadena-Aguirre  2 , Angelo So Taa Kum  2 , Paulo Ferreira Mega  2 , Pedro Henrique Veras Ayres da Silva  2 , Nelson Tomio Miyajima  2 , Wanderley Marques Bernardo  2 , Eduardo Guimarães Hourneaux de Moura  2
Affiliations
Meta-Analysis

Comparison of endoscopic submucosal dissection and transanal endoscopic surgery for the treatment of rectal neoplasia: A systematic review and meta-analysis

Igor Valdeir Gomes de Sousa et al. Clinics (Sao Paulo). .

Abstract

Background and aim: Minimally invasive techniques offer alternatives to conventional surgery in the treatment of early-stage colorectal cancer, reducing morbidity. Transanal Endoscopic Microsurgery (TEM) and Transanal Minimally Invasive Surgery (TAMIS) are widely used, while Endoscopic Submucosal Dissection (ESD) is gaining attention for its ability to achieve complete resection with low recurrence rates. This study compares the efficacy and safety of ESD with Transanal Endoscopic Surgery (TES).

Methods: The authors performed a systematic review and meta-analysis of comparative studies involving patients with endoscopically resectable rectal lesions. Electronic searches were conducted in MEDLINE, EMBASE, Cochrane, and LILACS. Outcomes included recurrence rate, complete resection, en bloc resection, hospital stay, procedure time, and complication rate.

Results: The analysis included ten observational studies and one Randomized Controlled Trial (RCT) involving 1,094 patients. No significant differences were found in terms of recurrence rate, en bloc resection, R0 resection, and complications between techniques. The RCT showed a shorter procedure time in the TES (RD = 16.6; 95 % CI 8.88 to 24.32; p < 0.0001), whereas observational studies found no significant difference. In addition, observational studies found a shorter hospital stay duration in the ESD (MD = -1.22; 95 % CI -2.11 to -0.33; I2 = 82 %; p < 0.007), while the RCT found no difference.

Conclusion: ESD and TES are safe and effective for the treatment of early-stage rectal tumors. Rates of local recurrence, block resection, R0 resection, complications, and procedure time were similar. However, the RCT showed a shorter procedure time with TES, while observational studies showed a shorter hospital stay with ESD.

Keywords: Endoscopic submucosal dissection; Rectal neoplasms; Transanal endoscopic microsurgery; Transanal minimally invasive surgery.

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Conflict of interest statement

Declaration of competing interest The authors declare no conflicts of interest.

Figures

Fig 1
Fig. 1
PRISMA flow diagram.
Fig 2
Fig. 2
Risk of bias assessment assessed by ROBINS-I.
Fig 3
Fig. 3
Risk of bias assessment assessed by Rob2.
Fig 4
Fig. 4
GRADEpro – Observational studies. Assessment of the quality of evidence for the comparison of ESD vs. TES for the treatment of early rectal neoplasia.
Fig 5
Fig. 5
GRADEpro – RCT. Assessment of the quality of evidence for the comparison of ESD vs. TES for the treatment of early rectal neoplasia.
Fig 6
Fig. 6
Forest plot recurrence rate.
Fig 7
Fig. 7
Forest plot en bloc resection rate.
Fig 8
Fig. 8
Forest plot R0 resection rate.
Fig 9
Fig. 9
Forest plot perforation rate.
Fig 10
Fig. 10
Forest plot bleeding rate.
Fig 11
Fig. 11
Forest plot procedure time.
Fig 12
Fig. 12
Forest plot length of hospital stay.
See this image and copyright information in PMC

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