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

Table 3 Subgroup analysis (Japan and rest of the world) of pooled proportions and comparative meta-analysis of endoscopic submucosal dissection and endoscopic mucosal resection

	Japan papers	Pooled proportions (ESD)	Pooled proportions (EMR)	RR (CI)	P value	Rest of the world papers	Pooled proportions (ESD)	Pooled proportions (EMR)	RR (CI)	P value
Overall results
En bloc resection	6	89% (0.77-0.97)	53% (0.38-0.67)	1.658 (1.270-2.165)	< 0.001	5	90% (0.85-0.94)	41% (0.22-0.61)	2.201 (1.411-3.433)	0.001
Positive lateral margin	2	3% (0.00-0.06)	14% (0.09-0.19)	0.292 (0.089-0.955)	0.042	-	-	-	-	-
Positive vertical margin	1	5% (0.01-0.17)	1% (0.00-0.05)	4.368 (0.409-46.710)	0.223	-	-	-	-	-
Complete resection	2	79% (0.73-0.84)	53% (0.48-0.58)	1.452 (1.303-1.618)	< 0.001	6	85% (0.78-0.91)	59% (0.27-0.88)	1.562 (0.921-2.650)	0.098
Lymphovsacular invasion	1	6% (0.03-0.13)	0% (0.00-0.04)	4.352 (0.248-76.483)	0.315	-	-	-	-	-
Mean procedural time	4	-	-	72.106 (48.831-95.382)	< 0.001	4	-	-	73.916 (36.075-111.757)	< 0.001
Additional surgery	2	13% (0.07-0.21)	5% (0.02-0.09)	3.139 (1.360-7.243)	0.007	-	-	-	-	-
Perforation	11	4% (0.01-0.07)	0.0002% (0.00-0.00081)	9.586 (4.425-20.768)	< 0.001	7	8% (0.05-0.12)	1% (0.00-0.02)	4.602 (2.729-7.759)	< 0.001
Bleeding	8	2.4% (0.01-0.04)	2.1% (0.01-0.03)	1.267 (1.174-1.367)	< 0.001	6	5% (0.02- 0.11)	3% (0.01-0.06)	1.986 (0.716-5.508)	0.188
Recurrences	7	1% (0.01-0.02)	7% (0.02-0.15)	0.274 (0.071-1.054)	0.06	5	3% (0.00-0.08)	16% (0.04-0.32)	0.245 (0.073-0.819)	0.022
Sensitivity analysis (≥ 20 mm only)
En bloc resection	4	82% (0.72-0.91)	50% (0.33-0.67)	1.645 (1.174-2.306)	0.004	2	91% (0.88-0.93)	33% (0.28-0.37)	2.668 (1.752-4.063)	< 0.001
Positive lateral margin	2	3% (0.00-0.06)	14% (0.09-0.19)	0.292 (0.089-0.955)	0.042	-	-	-	-	-
Positive vertical margin	1	5% (0.01-0.17)	1% (0.00-0.07)	4.368 (0.409-46.710)	0.223	-	-	-	-	-
Complete resection	2	79% (0.73-0.84)	53% (0.48-0.58)	1.452 (1.303-1.618)	< 0.001	2	90% (0.87-0.93)	77% (0.73-0.82)	1.613 (0.209-12.452)	0.647
Lymphovsacular invasion	2	6% (0.03-0.13)	0% (0.00-0.04)	4.352 (0.248-76.483)	0.315	-	-	-	-	-
Mean procedural time	2	-	-	69.167 (48.446-89.888)	< 0.001	1	-	-	82.700 (67.578-97.822)	< 0.001
Additional surgery	2	13% (0.07-0.21)	5% (0.02-0.09)	3.139 (1.360-7.243)	0.007	-	-	-	-	-
Perforation	5	4% (0.01-0.07)	0% (0.00-0.01)	5.235 (2.123-12.910)	< 0.001	3	7% (0.05-0.10)	1% (0.00-0.03)	4.546 (1.674-12.346)	0.003
Bleeding	4	3% (0.00-0.07)	3% (0.01-0.05)	0.895 (0.438-1.829)	0.762	3	3% (0.00-0.08)	1% (0.00-0.04)	2.233 (0.489-10.197)	0.300
Recurrences	5	1% (0.00-0.02)	7% (0.02-0.15)	0.204 (0.097-0.429)	< 0.001	3	3% (0.00-0.10)	27% (0.10-0.20)	0.179 (0.032-0.990)	0.049

ESD: Endoscopic submucosal dissection; EMR: Endoscopic mucosal resection; RR: Relative risk; CI: Confidence interval.