Abstract
Background and study aims The advantages of endoscopic submucosal
dissection (ESD) over endoscopic mucosal resection for large colorectal neoplasms
are well
established; however, the technical challenges and lack of adequate training in ESD
limit its
widespread adoption in Western countries.
Methods A literature search was performed in Medline, Embase, Web
of Science, and the Cochrane Library for studies conducted in non-Asian countries
evaluating
the effectiveness of colorectal ESD. A random effects model was used to obtain pooled
en bloc,
R0 resection rates, and adverse events (AEs).
Results Thirty-three studies comprising 3,958 ESD procedures met
the inclusion criteria. Of the polyps, 96.7% (2,817 of 2913) were ≥ 2 cm. Pooled en
bloc
resection (31 studies), R0 resection (29 studies), and curative resection rates were
84.6%
(95% confidence interval [CI] [83.3%–85.9%]), 75.6% (95% CI [74.1%–77.0%]), and 81.9%
(95% CI
[78.6%–84.9%]), respectively. Surgery for invasive cancer was performed in 4.8% (23
studies).
ESD-related perforation (25 studies) was observed in 5.5% and bleeding in 4.1% (delayed
bleeding 3.4%). 1.8% of patients underwent surgery for procedure-related complications.
A high
degree of heterogeneity was observed for en bloc resection, R0 resection, and curative
resection. Heterogeneity for AEs (perforation [I2 13%], delayed bleeding
[I2 30%], and overall bleeding [I2 49%]) was low to moderate.
Conclusions The effectiveness of colorectal ESD for large
colorectal polyps and early colorectal cancers is improving in Western countries,
and recent
resection rates are comparable to that seen in Asia. Colorectal perforation is still
observed
in about 5% of ESD; however, < 2% of patients need emergency surgery for AEs.
Keywords
Colorectal cancer - Endoscopy Lower GI Tract - Endoscopic resection (polypectomy,
ESD, EMRc, ...)
