Efficacy of endoscopic mucosal resection versus endoscopic submucosal dissection for rectal neuroendocrine tumors ≤10mm: a systematic review and meta-analysis.

BACKGROUND

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are surgical methods used for rectal neuroendocrine tumors (NETs) with diameters of ≤ 10 mm. However, which method has a higher performance remains uncertain.

OBJECTIVES

Evaluate which of the two methods shows a higher performance.

DESIGN

Systematic review and meta-analysis METHODS: Data from PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to 12 April 2022. Outcomes, including complete resection, en bloc resection, recurrence, perforation, bleeding, and procedure time, were pooled by 95% confidence intervals (95% CI) using a fixed- or random-effects model.

MAIN OUTCOME MEASURES

Complete resection, en bloc resection, and recurrence.

SAMPLE SIZE

18 studies, including 1168 patients were included in the study.

RESULTS

Eighteen retrospective cohort studies were included in this meta-analysis. There were no statistical differences in the rates of complete resection, en bloc resection, recurrence, perforation, and bleeding rates between EMR and ESD. However, a statistical difference was detected in the procedure time; EMR had a significantly shorter time (MD=-17.47, 95% CI=-22.31 - -12.62, <.00001).

CONCLUSIONS

EMR and ESD had similar efficacies and safety profiles in resectioning rectal NETs ≤ 10 mm. Even so, the advantages of EMR included a shorter operation time and expenditure. Thus, with respect to health economics, EMR outperformed ESD.

LIMITATION

Most of these studies are retrospective cohort studies instead of RCTs.

CONFLICT OF INTEREST

None.