Original article
Clinical endoscopy
Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection

https://doi.org/10.1016/j.gie.2014.07.034Get rights and content

Background

EMR and endoscopic submucosal dissection (ESD) are used frequently to remove colon neoplasms. However, the predominance of these procedures has not yet been thoroughly explored.

Objective

To compare the efficacy and adverse events related to EMR with those related to ESD for colon neoplasms.

Design

A meta-analysis of 8 studies published between 2005 and 2013.

Setting

Multicenter review.

Patients

Patients from 8 studies yielding 2299 lesions.

Interventions

EMR or ESD.

Main Outcome Measurements

En bloc resection, curative resection, recurrence, and adverse events.

Results

The pooled odds ratios (OR) (OR [95% confidence interval]) for the tumor size, length of the procedure, en bloc resection, curative resection, recurrence, additional surgery, delayed bleeding, and perforation by ESD versus EMR were 7.38 (6.42-8.34), 58.07 (36.27-79.88), 6.84 (3.30-14.18), 4.26 (3.77-6.57), 0.08 (0.04-0.17), 2.16 (1.16-4.03), 0.85 (0.45-1.60), and 4.96 (2.79-8.85), respectively.

Limitations

This analysis included only nonrandomized studies.

Conclusion

The size of the tumor and rate of en bloc resection and curative resection were higher, and the rate of recurrence was lower in the ESD group versus the EMR group. However, in the ESD group, the procedure was longer, and the rate of additional surgery and perforation was higher, suggesting that the indications for ESD should therefore be rigorously determined in order to avoid such problems.

Section snippets

Retrieval strategy and quality assessment

A meta-analysis was conducted to evaluate the predominance of EMR and ESD for removing colon tumors. The data included in PubMed (published from 2005 to 2013) and the Cochrane Controlled Trials Register (2005 to 2013) were searched. The keywords used were as follows: a combination of “endoscopic mucosal resection,” “large polyp resection,” “piecemeal polypectomy,” “submucosal injection,” “hot biopsy,” “strip biopsy” or “endoscopic submucosal dissection” and “colon,” “colonic” or “colorectal.”

Evaluation and details of the selected studies

A total of 247 reports were retrieved (Fig. 1). After screening the titles, abstracts, or full text and excluding reviews, case reports, uncontrolled tests, and basic research studies, 9 studies were selected.24, 28, 42, 43, 44, 45, 46, 47, 48 Among these 9 studies, 1 study, in which clinical records were collected from 18 institutions in Japan, was excluded because some of the enrolled cases overlapped with those of other reports.48 Thereafter, the risk of bias was assessed according to the

Discussion

The present meta-analysis compared the efficacy of and adverse events associated with EMR and ESD for removing colon tumors based on 8 recently published articles.24, 28, 42, 43, 44, 45, 46, 47 The findings indicated that the rates of en bloc resection and curative resection were much higher, and the rate of recurrence was much lower in the ESD group (91.7%, 80.3%, and 0.9%, respectively) than in the EMR group (46.7%, 42.3%, and 12.2%, respectively). Furthermore, the size of tumors treated with

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    DISCLOSURE: All authors disclosed no financial relationships relevant to this article.

    See CME section; p. 748.

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