Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for removal of colorectal adenomas

Colorectal adenomas are benign polyps but might constitute precursor lesions that can progress to cancer. Adenomas can be removed during colonoscopy to prevent progression to malignant disease. Two main methods are available: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202222 Registration no: SBU 2022/575

Question

What systematic reviews are there on the comparison of EMR and ESD for the removal of colorectal adenomas regarding recurrence and adverse events?

Identified literature

No relevant systematic reviews with low or moderate risk of bias were identified. In twelve relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported [1-12].

References

  1. Arezzo A, Passera R, Marchese N, Galloro G, Manta R, Cirocchi R. Systematic review and meta-analysis of endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal lesions. United European Gastroenterol J. 2016;4(1):18-29. Available from: https://doi.org/10.1177/2050640615585470.
  2. De Ceglie A, Hassan C, Mangiavillano B, Matsuda T, Saito Y, Ridola L, et al. Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: A systematic review. Crit Rev Oncol Hematol. 2016;104:138-55. Available from: https://doi.org/10.1016/j.critrevonc.2016.06.008.
  3. Kothari ST, Huang RJ, Shaukat A, Agrawal D, Buxbaum JL, Abbas Fehmi SM, et al. ASGE review of adverse events in colonoscopy. Gastrointest Endosc. 2019;90(6):863-76 e33. Available from: https://doi.org/10.1016/j.gie.2019.07.033.
  4. Liggi M. Endoscopic submucosal dissection, endoscopic mucosal resection and hybrid techniques for large nonpedunculated colorectal tumors: A meta analysis and systematic review. J Intervent Gastroenterol. 2014;4(4):117-25. Available from: https://doi.org/10.7178/jig.173.
  5. Lim XC, Nistala KRY, Ng CH, Lin SY, Tan DJH, Ho KY, et al. Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal polyps: A meta-analysis and meta-regression with single arm analysis. World J Gastroenterol. 2021;27(25):3925-39. Available from: https://doi.org/10.3748/wjg.v27.i25.3925.
  6. Liu J, He Y, Wang Z, Zhang S. Endoscopic resection for colorectal laterally spreading tumors in East Asian countries: a systematic review. Transl Cancer Res. 2022;11(5):1413-22. Available from: https://doi.org/10.21037/tcr-21-2074.
  7. Rotermund C, Djinbachian R, Taghiakbari M, Enderle MD, Eickhoff A, von Renteln D. Recurrence rates after endoscopic resection of large colorectal polyps: A systematic review and meta-analysis. World J Gastroenterol. 2022;28(29):4007-18. Available from: https://doi.org/10.3748/wjg.v28.i29.4007.
  8. Russo P, Barbeiro S, Awadie H, Libanio D, Dinis-Ribeiro M, Bourke M. Management of colorectal laterally spreading tumors: a systematic review and meta-analysis. Endosc Int Open. 2019;7(2):E239-E59. Available from: https://doi.org/10.1055/a-0732-487.
  9. Shahini E, Passera R, Lo Secco G, Arezzo A. A systematic review and meta-analysis of endoscopic mucosal resection vs endoscopic submucosal dissection for colorectal sessile/non-polypoid lesions. Minim Invasive Ther Allied Technol. 2022;31(6):835-47. Available from: https://doi.org/10.1080/13645706.2022.2032759.
  10. Tan DJH, Ng CH, Lim XC, Lim WH, Yuen LZH, Koh JH, et al. Is underwater endoscopic mucosal resection of colon polyps superior to conventional techniques? A network analysis of endoscopic mucosal resection and submucosal dissection. Endosc Int Open. 2022;10(1):E154-E62. Available from: https://doi.org/10.1055/a-1633-3230.
  11. Wang J, Zhang XH, Ge J, Yang CM, Liu JY, Zhao SL. Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors: a meta-analysis. World J Gastroenterol. 2014;20(25):8282-7. Available from: https://doi.org/10.3748/wjg.v20.i25.8282.
  12. Zhao HJ, Yin J, Ji CY, Wang X, Wang N. Endoscopic mucosal resection versus endoscopic submucosal dissection for colorectal laterally spreading tumors: a meta-analysis. Rev Esp Enferm Dig. 2020;112(12):941-7. Available from: https://doi.org/10.17235/reed.2020.6681/2019.

 

Litterature search

Medline via OvidSP 18 Oct 2022

Title: Advanced polypectomy
/ = Term from the MeSH controlled vocabulary; exp= Term from MeSH including terms found below this term in the MeSH hierarchy;.ti,ab = Title or abstract; .tw = Title or abstract;.kf = Keywords;.bt = Book title. NLM Bookshelf.; .pt = Publication type; .ja = Journal abbreviation;adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other.;* or $ = Truncation;“ “ = Citation Marks; searches for an exact phrase
Search terms Items found
1. exp colon/ or exp colorectal neoplasms/ 29,0052
2. (colo* or rect* or sigmoid*).ti,ab,kf,bt. 1,197,369
3. or/1-2 1,242,923
Intervention:
4. Endoscopic Mucosal Resection/ 3,124
5. (endoscopic adj2 (resection* or dissection* or therap* or mucosectomy)).ti,ab,kf,bt. 20,687
6. (m-EMR or mEMR or c-EMR or cEMR or u-EMR or uEMR or p-EMR or pEMR or piecemeal* or ESD).ti,ab,kf,bt. 8,153
7. polypectomy.ti,ab,kf,bt. 5,422
8. or/4-7 29,599
Study types: systematic reviews and meta-analysis
9. ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/)) 398,891
Combined sets:
10. 3 and 8 7,811
11. 9 and 10 235
Final result
12. 11 235
Population:

Scopus via scopus.com 18 Oct 2022

Title: Advanced polypectomy
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords);W/n = Within. Proximity operator retrieving terms within n words from each other.;DOCTYPE = Publication type;“re” = review;“le” = letter;“ed” = editorial;“ch” = book chapter; “cp”=conference proceedings;* = Truncation;“ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
&nbsp TITLE-ABS-KEY ( colo* OR rect* OR sigmoid* ) 3,200,777
Intervention:
2. TITLE-ABS-KEY ( endoscopic W/1 ( resection* OR dissection* OR therap* OR mucosectomy ) ) 34,134
3. TITLE-ABS-KEY ( m-emr OR memr OR c-emr OR cemr OR u-emr OR uemr OR p-emr OR pemr OR piecemeal* OR esd ) 27,371
4. TITLE-ABS-KEY ( polypectomy ) 11,855
5. #2 OR #3 OR #4 66,808
Study types: systematic reviews and meta-analysis / randomized controlled trials
6. TITLE-ABS-KEY ( ( systematic  W/2 review ) OR "meta analy*" OR metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”)) 578,736
Combined sets:
7. #1 AND #5 15,789
8. #6 AND #7 463
Final result
  #8 463

INATHA via database.inahta.org 18 Oct 2022

Title: Advanced polypectomy
Title = Title; abs = Abstract; mh = Term from the MeSH controlled vocabulary
Search terms Items found
Intervention:    
  (polypectomy)[Title] OR (polypectomy)[abs] OR (endoscopic mucosal resection)[mh] OR (endoscopic mucosal resection*)[Title] OR (endoscopic mucosal resection*)[abs] OR (endoscopic submucosal dissection*)[Title] OR (endoscopic submucosal dissection*)[abs] OR (EMR)[Title] OR (EMR)[abs] OR (ESD)[Title] OR (ESD)[abs] OR (piecemeal*)[Title] OR (piecemeal*)[abs] 30
Final result
2. 1 30
Page published
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