Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal polyps:A meta-analysis and metaregression with single arm analysis

作     者：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 

作者机构：Yong Loo Lin School of MedicineNational University of SingaporeSingapore 117597Singapore Department of MedicineNational University HospitalSingapore 119074Singapore Department of SurgeryNational University HospitalSingapore 119074Singapore 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2021年第27卷第25期

页      面：3925-3939页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Endoscopic mucosal resection Endoscopy Colonic polyps Colorectal neoplasm Colonoscopy 

摘      要：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 *** 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 *** 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 *** Of 281344 colorectal polyps from 21 studies were *** compared to EMR,the pooled analysis revealed ESD was associated with higher en bloc and complete resection rate,and lower lateral margin involvement and *** led to increased procedural time,need for additional surgery,and perforation *** significant difference in bleeding risk was found between the two ***-regression analysis suggested only right colonic polyps correlated with an increased perforation risk in *** including polyp size and invasion depth did not significantly influence the en bloc and complete resection rate,bleeding risk and *** 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 *** ESD resulted in better resection outcomes and lower recurrence compared to *** 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.