Lim XC, Nistala KRY, Ng CH, Lin SY, Tan DJH, Ho KY, Chong CS, Muthiah M. Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal polyps: A meta-analysis and meta-regression with single arm analysis. World J Gastroenterol 2021; 27(25): 3925-3939 [PMID: 34321855 DOI: 10.3748/wjg.v27.i25.3925]
Corresponding Author of This Article
Mark Muthiah, MBBS, MRCP, MMed, Assistant Professor, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. mdcmdm@nus.edu.sg
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
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/
World J Gastroenterol. Jul 7, 2021; 27(25): 3925-3939 Published online Jul 7, 2021. doi: 10.3748/wjg.v27.i25.3925
Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal polyps: A meta-analysis and meta-regression with single arm analysis
Xiong Chang Lim, Kameswara Rishi Yeshayahu Nistala, Cheng Han Ng, Snow Yunni Lin, Darren Jun Hao Tan, Khek-Yu Ho, Choon-Seng Chong, Mark Muthiah
Xiong Chang Lim, Kameswara Rishi Yeshayahu Nistala, Cheng Han Ng, Snow Yunni Lin, Darren Jun Hao Tan, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
Khek-Yu Ho, Mark Muthiah, Department of Medicine, National University Hospital, Singapore 119074, Singapore
Choon-Seng Chong, Department of Surgery, National University Hospital, Singapore 119074, Singapore
Author contributions: Lim XC, Nistala KRY, Ng CH, Ho KY, Muthiah M and Chong CS were involved in the conceptualization of the paper; Lim XC and Nistala KRY were involved in the acquisition of data; Lim XC, Nistala KRY, Ng CH, Lin SY, Tan DJH, Ho KY, Muthiah M and Chong CS were involved in the data analysis and interpretation; Lim XC, Nistala KRY and Ng CH were involved in writing of first draft; Ho KY, Muthiah M, Chong CS were involved in the reviewing of the drafts; all eight authors approved the final manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Mark Muthiah, MBBS, MRCP, MMed, Assistant Professor, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. mdcmdm@nus.edu.sg
Received: February 24, 2021 Peer-review started: February 24, 2021 First decision: April 18, 2021 Revised: April 21, 2021 Accepted: June 1, 2021 Article in press: June 1, 2021 Published online: July 7, 2021
Abstract
BACKGROUND
Endoscopic submucosal dissection (ESD) has shown to be effective in management of colorectal neoplasm in the Asian countries, while its implementation in Western countries where endoscopic mucosal resection (EMR) is preferred is still debatable.
AIM
To compare the surgical, histological, and oncological outcomes between ESD and EMR in the treatment of colorectal polyps, with subgroup analysis comparing the efficacy of ESD and EMR between Japan and the rest of the world.
METHODS
Embase and Medline databases were searched from inception to October 2020 in accordance with PRISMA guidelines for studies comparing en bloc, complete resection, margin involvement, resection time, need for additional surgery, complications, and recurrence rate of ESD with EMR.
RESULTS
Of 281344 colorectal polyps from 21 studies were included. When compared to EMR, the pooled analysis revealed ESD was associated with higher en bloc and complete resection rate, and lower lateral margin involvement and recurrence. ESD led to increased procedural time, need for additional surgery, and perforation risk. No significant difference in bleeding risk was found between the two groups. Meta-regression analysis suggested only right colonic polyps correlated with an increased perforation risk in ESD. Confounders including polyp size and invasion depth did not significantly influence the en bloc and complete resection rate, bleeding risk and recurrence. In subgroup analysis, Japan performed better than the rest of the world in both ESD and EMR with perforation risk of 4% and 0.0002%, respectively, as compared to perforation risk of 8% and 1%, respectively, in reports coming from rest of the world.
CONCLUSION
ESD resulted in better resection outcomes and lower recurrence compared to EMR. With appropriate training, ESD is preferred over EMR as the first-line therapy for resection of colorectal polyps, without restricting to lesions greater than 20 mm and those with high suspicion of submucosal invasion.
Core Tip: The present study is the most extensive meta-analysis evaluating the surgical, histological, and oncological outcomes of endoscopic submucosal dissection (ESD) in comparison to endoscopic mucosal resection (EMR) in the treatment of colorectal polyps. Our analysis also showed the increased proficiency in performing ESD and EMR in Japan as compared to the rest of the world.
