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CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(02): E239-E259
DOI: 10.1055/a-0732-487
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Management of colorectal laterally spreading tumors: a systematic review and meta-analysis

Pedro Russo   *
1   Gastroenterology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
,
Sandra Barbeiro   *
2   Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
,
Halim Awadie
3   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Diogo Libânio
4   Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
,
Mario Dinis-Ribeiro
4   Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
5   CINTESIS/MEDCIDS, Porto Faculty of Medicine, Portugal
,
Michael Bourke
3   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
6   Westmead Clinical School, University of Sydney, New South Wales, Australia
› Author Affiliations
Further Information

Publication History

submitted 22 January 2018

accepted after revision 04 July 2018

Publication Date:
30 January 2019 (online)

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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.

* Drs. Russo and Barbeiro: These authors contributed equally.


Refers to:

Will endoscopic submucosal dissection (ESD) become the gold standard for laterally spreading tumors (LST)?Endosc Int Open 2019; 07(02): E260-E263
DOI: 10.1055/a-0808-4580

 

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