Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: A systematic review

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• 作者：Antonella De Ceglie^aAuthor Vitae ; Cesare Hassan^bAuthor Vitae ; Benedetto Mangiavillano^aAuthor Vitae ; Takahisa Matsuda^cAuthor Vitae ; Yutaka Saito^cAuthor Vitae ; Lorenzo Ridola^dAuthor Vitae ; Pradeep Bhandari^eAuthor Vitae ; Federica Boeri^aAuthor Vitae ; Massimo Conio^a ; ^{mxconio@tin.it" class="auth_mail" title="E-mail the corresponding author}Author Vitae
• 关键词：Colorectal lesion ; laterally spreading tumor ; LST ; endoscopic mucosa resection ; EMR ; endoscopic submucosal dissection ; ESD
• 刊名：Critical Reviews in Oncology and Hematology
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：104
• 期：Complete
• 页码：138-155
• 全文大小：1342 K

文摘

To assess the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for the treatment of colorectal lesions.

Methods

A literature search was conducted from January 2000 to May 2015. The main outcomes were: recurrence after “en bloc” and “piecemeal” resection; procedure related adverse events; the EMR endoscopic success rate and the completely eradicated resection rate (R0) after ESD.

Results

A total of 66 studies were included in the analysis. The total number of lesions was 17950 (EMR: 11.873; ESD: 6077). Recurrence rate was higher in the EMR than ESD group (765/7303l vs. 50/3910 OR 8.19, 95% CI 6.2–10.9 p < 0.0001). EMR-en bloc resection was achieved in 6793/10803 lesions (62.8%) while ESD-en bloc resection was obtained in 5500/6077 lesions (90.5%) (OR 0.18, p < 0.0001, 95% CI 0.16–0.2). Perforation occurred more frequently in ESD than in EMR group (p < 0.0001, OR 0.19, 95% CI 0.15–0.24).

Conclusions

Endoscopic resection of large colorectal lesions is safe and effective. Compared with EMR, ESD results in higher “en bloc” resection rate and lower local recurrence rate, however ESD has high procedure-related complication rates.