Endoscopic Mucosal Resection And Endoscopic Submucosal Dissection For Laterally Spreading Tumors: A Meta-analysis

Objective: To assess the efficacy and safety of endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)for the treatment of laterally spreading tumors(LSTs).Methods: A literature search including Pubmed?Embase?the Cochrane Central Register Controlled Trials? CNKI and WANFANG database,range from January 1st,2000 to January 31 st,2018.Screening the literature according to certain inclusion and exclusion criteria.The Cochrane Collaboration's RevMan 5.3 Software to be used to investigate the en-bloc rate,procedure related adverse events and recurrence rate.Results:A total of 12 studies were included in the analysis.The total number of lesions of 3062(EMR 1906;ESD 1156).The en bloc resection rate of EMR was 42.8%(815/1906),ESD was 95%(1098/1156).ESD-en bloc resection rate was higher than EMR,the analysis show significantly differences [OR=0.07,95% CI(0.02,0.07),P<0.00001].The complete resection rate was higher in ESD was 93.2%(109/117)than in EMR was71.9%(92/128),there were significant difference [OR=0.12,95% CI(0.05,0.29),P<0.00001].Bleeding occurred frequently in EMR than ESD(4.2% vs3.5%),there was no significant difference in Statistics [OR=1.04,95% CI(0.68,1.60),P=0.85].The perforation rate EMR and ESD was 1.8% vs 2.4%,there was significant difference [OR=0.56,95% CI(0.32,0.97),P=0.04].Recurrence rate was higher in EMR than ESD(15.9% vs 0.5%),There was significant difference [OR=23.06,95% CI(11.11,47.85),P<0.00001].Conclusions:Endoscopic resection of laterally spreading tumors(LSTs)is safe and effective.Compared with EMR,ESD results in higher en-bloc resection rate and complete resection rate and lower recurrence rate.So ESD is recommend for LSTs.