Chen Yi, Wu Zhengjie
Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Department of Infectious Diseases, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Minim Invasive Ther Allied Technol. 2025 Jun;34(3):177-186. doi: 10.1080/13645706.2024.2440403. Epub 2024 Dec 12.
Several modified endoscopic mucosal resection (EMR) techniques have been reported for colorectal tumors. Precutting-EMR (PEMR) is a modification wherein a circumferential mucosal incision is made around a lesion to facilitate en bloc resection. This review compared the efficacy and safety of PEMR with conventional EMR for colorectal lesions.
PubMed, Embase, Scopus, and Web of Science were searched for comparative studies available before February 15, 2024. This systematic review and meta-analysis were recorded in PROSPERO, identified as CRD42024509143.
Two hundred and eight studies underwent screening of which seven studies were found eligible. We found no significant difference in en bloc resection rates but complete resection rates were significantly better with PEMR. The duration of the procedure was significantly longer with PEMR as compared to EMR. There was no difference in the risk of delayed bleeding and recurrence between the two groups but the risk of perforation was significantly increased with PEMR.
The use of PEMR for colorectal lesions can improve complete resection rates, albeit at the cost of increased duration of the procedure and higher perforation rates compared to conventional EMR. PEMR may also have a tendency of better en bloc resection rates which needs to be confirmed by further studies.
已有多种改良内镜黏膜切除术（EMR）技术用于结直肠肿瘤。预切开EMR（PEMR）是一种改良技术，即在病变周围进行环形黏膜切口以利于整块切除。本综述比较了PEMR与传统EMR治疗结直肠病变的疗效和安全性。
检索了PubMed、Embase、Scopus和Web of Science数据库，查找2024年2月15日前的比较研究。本系统评价和荟萃分析已在PROSPERO中登记，登记号为CRD42024509143。
共筛选了208项研究，其中7项研究符合纳入标准。我们发现整块切除率无显著差异，但PEMR的完整切除率明显更高。与EMR相比，PEMR的手术时间明显更长。两组之间延迟出血和复发风险无差异，但PEMR的穿孔风险显著增加。
与传统EMR相比，使用PEMR治疗结直肠病变可提高完整切除率，尽管代价是手术时间延长和穿孔率升高。PEMR的整块切除率可能也有提高的趋势，这需要进一步研究证实。
