Meta-Analysis
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World J Gastroenterol. Jul 7, 2014; 20(25): 8282-8287
Published online Jul 7, 2014. doi: 10.3748/wjg.v20.i25.8282
Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors: A meta-analysis
Jing Wang, Xiao-Hua Zhang, Jian Ge, Chong-Mei Yang, Ji-Yong Liu, Shu-Lei Zhao
Jing Wang, Xiao-Hua Zhang, Jian Ge, Chong-Mei Yang, Ji-Yong Liu, Shu-Lei Zhao, Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
Author contributions: Zhao SL proposed the study; Zhao SL, Wang J, Zhang XH, Ge J, Yang CM, Liu JY performed the research and drafted the paper; Wang J collected and analyzed the data; all authors contributed to the design and interpretation of the study and further revision of the paper; Zhao SL is the supervisor.
Correspondence to: Shu-Lei Zhao, MD, Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Weiqi Rd, Jinan 250021, Shandong Province, China. wenzhu24@126.com
Telephone: +86-531-87987938 Fax: +86-531-87987938
Received: December 26, 2013
Revised: February 27, 2014
Accepted: April 21, 2014
Published online: July 7, 2014
Processing time: 189 Days and 2.2 Hours
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: Endoscopic submucosal dissection, Endoscopic mucosal resection, Colorectal tumors, En bloc resection, Local recurrence, Histological resection, Complication

Core tip: Endoscopic submucosal dissection (ESD) was originally developed for en bloc resection of lager, flat gastrointestinal tumors. Compared with endoscopic mucosal resection (EMR), ESD was considered to be more time consuming and have more complications for the treatment of colorectal tumors. This meta-analysis of six trials shows that compared with EMR, ESD gives higher en bloc resection rate and lower local recurrence rate for the treatment of colorectal tumors, without increasing the procedure-related complications. ESD should be considered in the endoscopic treatment of colorectal tumors.