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Background <p>Colorectal laterally spreading tumors (LSTs) larger than 20&#xa0;mm are significant precursors to colorectal cancer. Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are widely used treatments, but their comparative efficacy and safety remain controversial. This systematic review and meta-analysis aimed to compare ESD and EMR in terms of local recurrence, perforation, and delayed bleeding for colorectal LSTs &gt; 20&#xa0;mm.</p> Methods <p>Following PRISMA guidelines, a comprehensive literature search was conducted in PubMed, Embase, and Cochrane databases from inception to 1 May 2025. Studies comparing ESD and EMR for LSTs &gt; 20&#xa0;mm were included. Data were extracted and quality assessed using the Newcastle–Ottawa Scale and Cochrane Risk of Bias Tool. Random-effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs).</p> Results <p>Eight studies comprising 3024 patients were included. ESD was associated with significantly lower local recurrence compared to EMR (0.62% versus 12.02%; OR 0.07, 95% CI 0.03–0.13, <i>p</i> &lt; 0.01). However, ESD had a higher risk of perforation (5.38% versus 1.53%; OR 3.16, 95% CI 1.89–5.29, <i>p</i> &lt; 0.01). No significant difference was found in delayed bleeding rates (3.65% versus 3.75%; OR 1.01, 95% CI 0.65–1.55, <i>p</i> = 0.98). Heterogeneity was negligible across all outcomes (<i>I</i><sup>2</sup> &lt; 5%).</p> Conclusions <p>ESD significantly reduces recurrence risk for colorectal LSTs &gt; 20&#xa0;mm compared with EMR but carries a higher perforation risk. Bleeding rates are comparable between the two techniques. ESD is recommended in expert centers where technical proficiency can mitigate perforation risk, while EMR-treated patients require closer surveillance due to higher recurrence. Future studies should focus on optimizing techniques and clarifying strategies for different LST subtypes and locations.</p>

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Endoscopic submucosal dissection versus endoscopic mucosal resection for colorectal laterally spreading tumors (> 20 mm): a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月11日

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  • Q. Zeng,
  • L. Zhang,
  • T. Zhang,
  • T. Kong,
  • S. Xu,
  • C. Lan,
  • B. He

摘要

Background

Colorectal laterally spreading tumors (LSTs) larger than 20 mm are significant precursors to colorectal cancer. Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are widely used treatments, but their comparative efficacy and safety remain controversial. This systematic review and meta-analysis aimed to compare ESD and EMR in terms of local recurrence, perforation, and delayed bleeding for colorectal LSTs > 20 mm.

Methods

Following PRISMA guidelines, a comprehensive literature search was conducted in PubMed, Embase, and Cochrane databases from inception to 1 May 2025. Studies comparing ESD and EMR for LSTs > 20 mm were included. Data were extracted and quality assessed using the Newcastle–Ottawa Scale and Cochrane Risk of Bias Tool. Random-effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs).

Results

Eight studies comprising 3024 patients were included. ESD was associated with significantly lower local recurrence compared to EMR (0.62% versus 12.02%; OR 0.07, 95% CI 0.03–0.13, p < 0.01). However, ESD had a higher risk of perforation (5.38% versus 1.53%; OR 3.16, 95% CI 1.89–5.29, p < 0.01). No significant difference was found in delayed bleeding rates (3.65% versus 3.75%; OR 1.01, 95% CI 0.65–1.55, p = 0.98). Heterogeneity was negligible across all outcomes (I2 < 5%).

Conclusions

ESD significantly reduces recurrence risk for colorectal LSTs > 20 mm compared with EMR but carries a higher perforation risk. Bleeding rates are comparable between the two techniques. ESD is recommended in expert centers where technical proficiency can mitigate perforation risk, while EMR-treated patients require closer surveillance due to higher recurrence. Future studies should focus on optimizing techniques and clarifying strategies for different LST subtypes and locations.