Published online Jul 7, 2021. doi: 10.3748/wjg.v27.i25.3925
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
Processing time: 131 Days and 19.3 Hours
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.
Previous meta-analyses and systematic reviews comparing ESD with EMR included studies mainly conducted in Asia, with limited data coming from outside of Japan and did not control for confounders or lesions smaller than 20 mm.
To compare the outcomes of ESD and EMR in the treatment of colorectal polyps, with subgroup analysis comparing the efficacy of these two techniques between Japan and the rest of the world.
Embase and Medline databases were searched 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 in patients with colorectal lesions.
ESD was associated with better resection outcomes and lower recurrence rate when compared to EMR. Meta-regression analysis suggested only right colonic polyps correlated with an increased perforation risk in ESD, while confounders including polyp size and invasion depth did not significantly influence the resection outcomes, bleeding risk and recurrence. Subgroup analysis showed that Japan performed better than the rest of the world in both ESD and EMR with lower perforation risk.
This meta-analysis suggests that 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. Increased proficiency in performing ESD and EMR was shown in Japan as compared with the rest of the world.
This highlights the need to establish adequate training programs for colorectal ESD to be performed effectively. A randomized controlled trial is necessary to better understand the efficacy and safety of these techniques in the management of colorectal polyps.