Endoscopy 2025; 57(S 02): S209
DOI: 10.1055/s-0045-1805513
Abstracts | ESGE Days 2025
Moderated poster
ESD – Everything you want to know! 03/04/2025, 16:00 – 17:00 Poster Dome 2 (P0)

Comparative Efficacy and Safety of Endoscopic Submucosal Dissection versus Transanal Endoscopic Microsurgery for the Treatment of Early-Stage Rectal Cancer: A Systematic Review and Meta-analysis

V Lekakis
1   Academic Departement of Gastroenterology, Laiko General Hospital, Athens, Greece
,
I Karniadakis
2   Laiko Hospital, Athens, Greece
,
S Papadakos
1   Academic Departement of Gastroenterology, Laiko General Hospital, Athens, Greece
,
M Papatheodoridi
1   Academic Departement of Gastroenterology, Laiko General Hospital, Athens, Greece
,
D Kamberoglou
1   Academic Departement of Gastroenterology, Laiko General Hospital, Athens, Greece
,
G Bouga
1   Academic Departement of Gastroenterology, Laiko General Hospital, Athens, Greece
,
G Papatheodoridis
1   Academic Departement of Gastroenterology, Laiko General Hospital, Athens, Greece
,
A Koutsoumpas
1   Academic Departement of Gastroenterology, Laiko General Hospital, Athens, Greece
› Author Affiliations
› Further Information
Also available ateRef
 
 

    Aims Rectal cancer accounts for approximately 35% of colorectal cancer cases in the European Union. While advanced cases require invasive surgical interventions, early-stage rectal tumors can often be treated with minimally invasive techniques like Endoscopic Submucosal Dissection (ESD) and Transanal Endoscopic Microsurgery (TEM). This systematic review and meta-analysis aimed to compare the efficacy and safety of ESD and TEM for early-stage rectal cancer.

    Methods A thorough literature search was performed across PubMed, Scopus, Embase, and Cochrane databases through October 2024. Studies comparing ESD and TEM outcomes in adults with early-stage rectal cancer were included. Primary outcomes included R0 resection, recurrence rates, and overall complications, while secondary outcomes assessed postoperative bleeding, reoperation needs, perforation rates, operative time, and hospital stay duration. Statistical analyses employed fixed or random effects models based on data heterogeneity.

    Results Seven retrospective studies comprising 671 patients (388 ESD and 283 TEM) were analyzed. Pooled results indicated that ESD was associated with significantly higher en bloc resection rates (OR=0.29, 95%CI: 0.10–0.83, p=0.02) and lower recurrence rates (OR=0.29, 95%CI: 0.12–0.70, p=0.006) compared to TEM. Additionally, ESD demonstrated a lower overall complication rate (OR=0.50, 95%CI: 0.31–0.81, p=0.005). No significant differences were noted between ESD and TEM regarding operative time, postoperative bleeding, or reoperation needs.

    Conclusions ESD offers advantages over TEM in managing early-stage rectal cancer, achieving higher en bloc resection rates and reducing recurrence and complications. Despite its technical demands, ESD’s precision and favorable safety profile make it an appealing option, although treatment decisions should consider clinician expertise and resource availability.


     

    Conflicts of Interest

    Authors do not have any conflict of interest to disclose.

    Publication History

    Article published online:
    27 March 2025

    © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved.

    Georg Thieme Verlag KG
    Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany