Internal Medicine Residency Program.
Harbin Medical University, Harbin, China.
J Clin Gastroenterol. 2023;57(10):983-990. doi: 10.1097/MCG.0000000000001880. Epub 2023 Jun 28.
Early-stage gastrointestinal neoplasms are frequently treated with conventional endoscopic mucosal resection (C-EMR). However, C-EMR frequently leads to incomplete resection of large colorectal lesions. Tip-in endoscopic mucosal resection (EMR), which was recently introduced for en bloc resection of colorectal neoplasms, minimizes slippage during the procedure.
We conducted a systematic review and meta-analysis of published studies that compared Tip-in EMR with conventional EMR. We searched several electronic databases and included studies that reported on the primary outcomes of en bloc resection rate and complete resection rate, as well as secondary outcomes such as procedure time and procedure-related complications (including perforation and delayed bleeding rate). We used a random effects model to calculate odds ratios (ORs) with 95% CIs for dichotomous data and weighted mean differences with 95% CIs for continuous data. We also conducted several sensitivity analyses to assess the robustness of our findings.
A total of 11 studies involving 1244 lesions (684 in the Tip-in EMR group and 560 in C-EMR group) were included in the meta-analysis. Our meta-analysis showed that compared with conventional EMR, Tip-in EMR significantly increased the en bloc resection rate in patients with colorectal neoplasia (OR=3.61; 95% CI, 2.09-6.23; P <0.00001; I2 =0%) and had a higher complete resection rate (OR=2.49; 95% CI, 1.65-3.76; P <0.0001; I2 =0%). However, the procedure time and rates of procedure-related complications did not differ significantly between the 2 groups.
Tip-in EMR outperformed C-EMR for both the en bloc and complete resection of colorectal lesions with similar rates of procedural complications.
早期胃肠道肿瘤常采用传统内镜黏膜切除术（C-EMR）治疗。然而，C-EMR 常导致大肠较大病变切除不完全。Tip-in 内镜黏膜切除术（EMR）最近被引入，用于整块切除结直肠肿瘤，可最大限度减少手术过程中的滑脱。
我们对比较 Tip-in EMR 与传统 EMR 的已发表研究进行了系统评价和荟萃分析。我们搜索了多个电子数据库，并纳入了报告整块切除率和完全切除率等主要结局以及手术时间和与手术相关并发症（包括穿孔和迟发性出血率）等次要结局的研究。我们使用随机效应模型计算二分类数据的优势比（OR）及其 95%置信区间（CI）和连续数据的加权均数差及其 95%CI。我们还进行了几次敏感性分析，以评估我们研究结果的稳健性。
共有 11 项研究纳入 1244 处病变（Tip-in EMR 组 684 处，C-EMR 组 560 处）进行荟萃分析。我们的荟萃分析显示，与传统 EMR 相比，Tip-in EMR 显著提高了结直肠肿瘤患者的整块切除率（OR=3.61；95%CI，2.09-6.23；P<0.00001；I2=0%），且完全切除率更高（OR=2.49；95%CI，1.65-3.76；P<0.0001；I2=0%）。然而，两组间手术时间和与手术相关并发症的发生率无显著差异。
与 C-EMR 相比，Tip-in EMR 整块和完全切除结直肠病变的效果更好，且手术相关并发症发生率相似。
