Safety and efficacy of endoscopic submucosal dissection vs endoscopic mucosal resection in managing gastrointestinal tract tumors: a systematic review and meta-analysis
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are minimally invasive alternatives to surgery for gastrointestinal tumors, differing in technique, indications, and outcomes. This meta-analysis compared the efficacy and safety of ESD vs EMR.Methods Following PRISMA guidelines, PubMed, Cochrane, Google Scholar, and Scopus were searched. Binary outcomes were pooled as odds ratios (ORs) and continuous outcomes as standardized mean differences (SMDs), with 95% confidence intervals (CIs), using a random-effects model. Analyses were performed in R (v4.4.1), with significance set at P < 0.05.Results Twenty-five studies with 5283 patients (2234 ESD, 3049 EMR) were included. ESD achieved higher complete resection (OR, 5.77; 95% CI, 2.18–15.26; P < 0.001; I2 = 91%) and en bloc resection rates (OR, 13.46; 95% CI, 5.91–30.64; P < 0.001; I2 = 82%). It required longer procedural time (SMD, 1.73; 95% CI, 1.26–2.19; P < 0.01) but had lower piecemeal resection (OR, 0.06; 95% CI, 0.01–0.38; P = 0.003). Postendoscopic resection coagulation syndrome (PECS) was more frequent with ESD (OR, 2.40; 95% CI, 1.25–4.61; P = 0.008). No significant differences were found in delayed bleeding (P = 0.06) or recurrence (P = 0.61).Conclusions ESD provides superior complete and en bloc resection compared with EMR but involves longer procedures and higher PECS risk. Large-scale trials are needed to refine comparative outcomes.
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4416421189