Efficacy of endoscopic mucosal resection versus endoscopic submucosal dissection for rectal neuroendocrine tumors ≤10mm: a systematic review and meta-analysis

BACKGROUND: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are surgical methods used for rectal neuroendocrine tumors (NETs) with diameters of & LE; 10 mm. However, which method has a higher performance remains uncertain. OBJECTIVES: Evaluate which of the two methods shows a higher performance. DESIGN: Systematic review and meta-analysis METHODS: Data from PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to 12 April 2022. Outcomes, tion, bleeding, and procedure time, were pooled by 95% confidence intervals (95% CI) using a fixed- or random-effects model. tion, and recurrence. SAMPLE SIZE: 18 studies, including 1168 patients were included in the study. RESULTS: Eighteen retrospective cohort studies were included in this meta-analysis. There were no statistical differences in the rates of complete resection, en bloc resection, recurrence, perforation, and bleeding rates between EMR and ESD. However, a statistical difference was detected in the procedure time; EMR had a significantly shorter time (MD=-17.47, 95% CI=-22.31- -12.62, P<.00001). CONCLUSIONS: EMR and ESD had similar efficacies and safety profiles in resectioning rectal NETs & LE; 10 mm. Even so, the advantages of EMR included a shorter operation time and expenditure. Thus, with respect to health economics, EMR outperformed ESD. LIMITATION: Most of these studies are retrospective cohort studies instead of RCTs. CONFLICT OF INTEREST: None.