Colorectal endoscopic submucosal dissection: a systematic review and meta-analysis

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique for gastrointestinal tumor resection.
• Colorectal ESD offers a minimally invasive approach to tumor removal.

Purpose of the Study:

• To systematically review and evaluate the safety and efficacy of colorectal ESD.
• To assess the R0 resection, curative resection, and recurrence rates of colorectal ESD.

Main Methods:

• Comprehensive literature search of multiple databases (MEDLINE, EMBASE, Ovid, CINAHL, Cochrane).
• Meta-analysis of studies reporting on clinical efficacy and safety of colorectal ESD.
• Inclusion of 13,833 tumors in 13,603 patients treated between 1998 and 2014.

Main Results:

• R0 resection rate of 83% (95% CI, 80%-86%), with heterogeneity influenced by continent, study design, procedure duration, and tumor size.
• High endoscopic en bloc (92%) and curative resection (86%) rates.
• Low rates of immediate perforation (4.2%) and delayed major bleeding (2.1%), with minimal recurrence (1.0% overall).

Conclusions:

• Colorectal ESD is a safe and effective treatment for colorectal tumors.
• The procedure demonstrates favorable resection and low complication rates.
• Colorectal ESD warrants consideration as a first-line therapy when performed by expert operators.