Singh Sahib, Mohan Babu P, Vinayek Rakesh, Dutta Sudhir, Dahiya Dushyant S, Gangwani Manesh K, Suresh Kumar Vishnu C, Aswath Ganesh, Bhat Ishfaq, Inamdar Sumant, Sharma Neil, Adler Douglas G
Departments of Internal Medicine.
Department of Gastroenterology and Hepatology, Orlando Gastroenterology PA, Orlando, FL.
J Clin Gastroenterol. 2025 Feb 1;59(2):161-167. doi: 10.1097/MCG.0000000000001996.
Studies evaluating endoscopic full-thickness resection (EFTR) and endoscopic submucosal dissection (ESD) for complex colorectal lesions have shown variable results. We conducted a meta-analysis of the available data.
Online databases were searched for studies comparing EFTR versus ESD for complex colorectal lesions. The outcomes of interest were resection rates, procedure time (min), and complications. Pooled odds ratios (OR) and standardized mean difference (SMD) along with 95% CI were calculated.
A total of 4 studies with 530 patients (n=215 EFTR, n=315 ESD) were included. The mean follow-up duration was 5 months. The mean age of the patients was 68 years and 64% were men. The EFTR and ESD groups had similar rates of en bloc resection (OR: 1.73, 95% CI: 0.60-4.97, P =0.31) and R0 resection (OR: 1.52, 95% CI: 0.55-4.14, P =0.42). The EFTR group had significantly reduced procedure time (SMD -1.87, 95% CI: -3.13 to -0.61, P =0.004), total complications (OR: 0.24, 95% CI: 0.13-0.44, P <0.00001), perforation (OR: 0.12, 95% CI: 0.03-0.39, P =0.0005) and postresection electrocoagulation syndrome (OR: 0.06, 95% CI: 0.01-0.48, P =0.008). Delayed bleeding was similar in the 2 groups (OR: 0.80, 95% CI: 0.30-2.12, P =0.66). Residual/recurrent lesions were significantly higher in the EFTR group (OR: 4.67, 95% CI: 1.39-15.66, P =0.01).
This meta-analysis of small studies with high heterogeneity showed that EFTR and ESD have comparable resection rates for complex colorectal lesions. EFTR is faster and has fewer complications, but it increases residual or recurrent lesions.
评估内镜全层切除术（EFTR）和内镜黏膜下剥离术（ESD）治疗复杂结直肠病变的研究结果不一。我们对现有数据进行了荟萃分析。
检索在线数据库，查找比较EFTR与ESD治疗复杂结直肠病变的研究。感兴趣的结局指标为切除率、手术时间（分钟）和并发症。计算合并比值比（OR）和标准化均数差（SMD）以及95%置信区间。
共纳入4项研究，530例患者（EFTR组215例，ESD组315例）。平均随访时间为5个月。患者平均年龄为68岁，64%为男性。EFTR组和ESD组的整块切除率（OR：1.73，95%置信区间：0.60 - 4.97，P = 0.31）和R0切除率（OR：1.52，95%置信区间：0.55 - 4.14，P = 0.42）相似。EFTR组的手术时间显著缩短（SMD -1.87，95%置信区间：-3.13至-0.61，P = 0.004），总并发症（OR：0.24，95%置信区间：0.13 - 0.44，P < 0.00001）、穿孔（OR：0.12，95%置信区间：0.03 - 0.39，P = 0.0005）和切除后电凝综合征（OR：0.06，95%置信区间：0.01 - 0.48，P = 0.008）发生率更低。两组的延迟出血发生率相似（OR：0.80，95%置信区间：0.30 - 2.12，P = 0.66）。EFTR组的残留/复发病变显著更高（OR：4.67，95%置信区间：1.39 - 15.66，P = 0.01）。
这项对异质性高的小型研究的荟萃分析表明，EFTR和ESD治疗复杂结直肠病变的切除率相当。EFTR速度更快且并发症更少，但会增加残留或复发病变。
