Abstract
Objective and study aims To evaluate the efficacy and safety of different endoscopic resection techniques
for laterally spreading colorectal tumors (LST).
Methods Relevant studies were identified in three electronic databases (PubMed, ISI and Cochrane
Central Register). We considered all clinical studies in which colorectal LST were
treated with endoscopic resection (endoscopic mucosal resection [EMR] and/or endoscopic
submucosal dissection [ESD]) and/or transanal minimally invasive surgery (TEMS). Rates
of en-bloc/piecemeal resection, complete endoscopic resection, R0 resection, curative
resection, adverse events (AEs) or recurrence, were extracted. Study quality was assessed
with the Newcastle-Ottawa Scale and a meta-analysis was performed using a random-effects
model.
Results Forty-nine studies were included. Complete resection was similar between techniques
(EMR 99.5 % [95 % CI 98.6 %-100 %] vs. ESD 97.9 % [95 % CI 96.1 – 99.2 %]), being
curative in 1685/1895 (13 studies, pooled curative resection 90 %, 95 % CI 86.6 – 92.9 %,
I2 = 79 %) with non-significantly higher curative resection rates with ESD (93.6 %,
95 % CI 91.3 – 95.5 %, vs. 84 % 95 % CI 78.1 – 89.3 % with EMR). ESD was also associated
with a significantly higher perforation risk (pooled incidence 5.9 %, 95 % CI 4.3 – 7.9 %,
vs. EMR 1.2 %, 95 % CI 0.5 – 2.3 %) while bleeding was significantly more frequent
with EMR (9.6 %, 95 % CI 6.5 – 13.2 %; vs. ESD 2.8 %, 95 % CI 1.9 – 4.0 %). Procedure-related
mortality was 0.1 %. Recurrence occurred in 5.5 %, more often with EMR (12.6 %, 95 %
CI 9.1 – 16.6 % vs. ESD 1.1 %, 95 % CI 0.3 – 2.5 %), with most amenable to successful
endoscopic treatment (87.7 %, 95 % CI 81.1 – 93.1 %). Surgery was limited to 2.7 %
of the lesions, 0.5 % due to AEs. No data of TEMS were available for LST.
Conclusions EMR and ESD are both effective and safe and are associated with a very low risk of
procedure related mortality.
