Meta-Analysis
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Apr 26, 2016; 4(2): 44-54
Published online Apr 26, 2016. doi: 10.13105/wjma.v4.i2.44
Meta-analysis comparing differing methods of endoscopic therapy for colorectal lesions
Nisha Patel, James Alexander, Hutan Ashrafian, Thanos Athanasiou, Ara Darzi, Julian Teare
Nisha Patel, James Alexander, Julian Teare, Department of Gastroenterology, St Mary’s Hospital, Imperial College London, London W2 1NY, United Kingdom
Hutan Ashrafian, Thanos Athanasiou, Ara Darzi, Department of Surgery and Cancer, St Mary’s Hospital, Imperial College London, London, London W2 1NY, United Kingdom
Author contributions: Patel N designed this paper; Patel N, Alexander J and Ashrafian H analysed and interpreted the data; Ashrafian H, Athanasiou T, Darzi A and Teare J criticised revision of the article for important intellectual content; all authors have approved the final draft submitted.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nisha Patel, BSc, MBBS, MRCP, Clinical Research Fellow, Department of Gastroenterology, St Mary’s Hospital, Imperial College London, Praed Street, London W2 1NY, United Kingdom. nishakpatel1@gmail.com
Telephone: +44-207-3717158 Fax: +44-203-3126950
Received: May 19, 2015
Peer-review started: May 20, 2015
First decision: June 19, 2015
Revised: July 18, 2015
Accepted: November 9, 2015
Article in press: January 4, 2016
Published online: April 26, 2016
Abstract

AIM: To compare the outcomes of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) of colorectal lesions.

METHODS: An electronic systematic literature search of four computerized databases was performed in July 2014 identifying studies reporting the outcomes of colorectal ESD and EMR. The primary outcome measures were en-bloc resection rate, endoscopic clearance rate and lesion recurrence rate of the patients followed up. The secondary outcome was the complication rate (including bleeding, perforation and surgery post EMR or ESD rate). Statistical pooling and random effects modelling of the studies calculating risk difference, heterogeneity and assessment of bias and quality were performed.

RESULTS: Six observational studies reporting the outcomes of 1324 procedures were included. The en-bloc resection rate was 50% higher in the ESD group than in the EMR group (95%CI: 0.17-0.83, P < 0.0001, I2 = 99.7%). Endoscopic clearance rates were also significantly higher in the ESD group (95%CI: -0.06-0.02, P < 0.0001, I2 = 92.5%). The perforation rate was 7% higher in the ESD group than the EMR group (95%CI: 0.05-0.09, P > 0.05, I2 = 41.1%) and the rate of recurrence was 50% higher in the EMR group than in the ESD group (95%CI: 0.20-0.79, P < 0.001, I2 = 99.5%). Heterogeneity remained consistent when subgroup analysis of high quality studies was performed (with the exception of piecemeal resection rate), and overall effect sizes remained unchanged for all outcomes.

CONCLUSION: ESD demonstrates higher en-bloc resection rates and lower recurrence rates compared to colorectal EMR. Differences in outcomes may benefit from increased assessment through well-designed comparative studies.

Keywords: Colorectal, Colonic polyp, Endoscopic mucosal resection, Endoscopic submucosal dissection, Colorectal cancer

Core tip: Endoscopic mucosal resection (EMR) is the conventional resection method of colorectal polyps. However certain lesions such as large sessile polyps can be challenging. Piecemeal resection has been shown to result in a high recurrence rate requiring further endoscopic sessions or surgery. Colorectal endoscopic submucosal dissection (ESD) is still at a relatively early stage, there are very few studies directly comparing the two modalities, few randomised controlled trials and fewer still reporting longer-term outcomes. This meta-analysis reports mid-term follow-up outcomes of colorectal ESD and EMR. ESD demonstrates higher en-bloc resection rates and lower mid-term recurrence rates compared to colorectal EMR albeit with higher complication rates.