The efficacy and safety of precutting-endoscopic mucosal resection for colorectal tumors: a systematic review and meta-analysis

BackgroundSeveral 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.MethodsPubMed, 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.ResultsTwo 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.ConclusionsThe 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.