Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Sep 14, 2009; 15(34): 4273-4277
Published online Sep 14, 2009. doi: 10.3748/wjg.15.4273
Meta-analysis and systematic review of colorectal endoscopic mucosal resection
Srinivas R Puli, Yasuo Kakugawa, Takuji Gotoda, Daphne Antillon, Yutaka Saito, Mainor R Antillon
Srinivas R Puli, Daphne Antillon, Mainor R Antillon, Division of Gastroenterology and Hepatology, University of Missouri-Columbia, Columbia, MO 65212, United States
Yasuo Kakugawa, Takuji Gotoda, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
Author contributions: Puli SR collected data, performed analysis and wrote paper; Kakugawa Y collected data and edited paper; Gotoda T, Antillon D and Saito Y edited paper; Antillon MR conceived the idea and edited manuscript.
Correspondence to: Mainor R Antillon, MD, Division of Gastroenterology, University of Missouri-Columbia, 5 Hospital Drive, CE443, Columbia, MO 65212, United States. antillonmr@missouri.edu
Telephone: +1-573-8821013 Fax: +1-573-8844595
Received: March 2, 2009
Revised: June 16, 2009
Accepted: June 23, 2009
Published online: September 14, 2009
Abstract

AIM: To evaluate the proportion of successful complete cure en-bloc resections of large colorectal polyps achieved by endoscopic mucosal resection (EMR).

METHODS: Studies using the EMR technique to resect large colorectal polyps were selected. Successful complete cure en-bloc resection was defined as one piece margin-free polyp resection. Articles were searched for in Medline, Pubmed, and the Cochrane Control Trial Registry, among other sources.

RESULTS: An initial search identified 2620 reference articles, from which 429 relevant articles were selected and reviewed. Data was extracted from 25 studies (n = 5221) which met the inclusion criteria. All the studies used snares to perform EMR. Pooled proportion of en-bloc resections using a random effect model was 62.85% (95% CI: 51.50-73.52). The pooled proportion for complete cure en-bloc resections using a random effect model was 58.66% (95% CI: 47.14-69.71). With higher patient load (> 200 patients), this complete cure en-bloc resection rate improves from 44.19% (95% CI: 24.31-65.09) to 69.17% (95% CI: 51.11-84.61).

CONCLUSION: EMR is an effective technique for the resection of large colorectal polyps and offers an alternative to surgery.

Keywords: Meta-analysis; Systematic review; Polyps; Endoscopic mucosal resection; En-bloc resection