Effectiveness Of Endoscopic Mucosal Resection Research Articles

Effect of endoscopic mucosal resection and endoscopic submucosal dissection on postoperative wound bleeding‐related complications in patients with superficial esophageal cancer: A meta‐analysis

AbstractOperative therapy for superficial esophagus carcinoma is the main way to treat the disease. Endoscopic excision of lesions in the esophagus has become an alternative to surgical treatment for patients with esophageal carcinoma. To overcome the disadvantages of endoscope mucosa excision (EMR), an endoscopic submucosal dissection (ESD) technique has been developed. Although ESD is one of the most effective methods of endoscopy in patients with digestive tract tumors, there are potential complications after surgery, including hemorrhage in the surgical area and stenosis of the esophagus. The objective of this study was to evaluate EMR versus ESD based on post‐operative hemorrhage and esophagus stenosis. All the related articles were retrieved from the e‐databases. The main results were postoperative perforation, hemorrhage, and stenosis after surgery. There were no statistically significant differences in the incidence of post‐operative wound hemorrhage (OR, 1.08; 95% CI, 0.36–3.29 p = 0.89). Similarly, there were no statistically significant differences in the rate of perforation after surgery (OR, 0.57; 95% CI, 0.17–1.95 p = 0.37). There were no statistically significant differences in the incidence of esophageal stricture after surgery (OR, 1.15; 95% CI, 0.26–5.15 p = 0.85). This analysis was different from the earlier meta‐analysis because ESD and EMR did not show any notable differences with respect to the incidence of perforation after surgery, the hemorrhage of the wound or the stenosis of the esophagus. These findings must, however, be supported by more high‐quality studies.

Effect of endoscopic mucosal resection and endoscopic submucosal dissection on postoperative wound complications in patients with gastric cancer: A meta-analysis.

Endoscopic submucosa dissection (ESD) allows complete excision of the whole lesion, which results in a higher percentage of complete excision and an improved quality of life by minimizing the amount of excision as opposed to an endoscopic mucosal resection (EMR). Although ESD is now being carried out in the majority of hospitals, ESD's possible complications (such as trauma and perforation) have given rise to doubts about ESD practices in patients with early-stage stomach cancer when deciding on therapy and reimbursement. This study was designed to evaluate the effectiveness and safety of ESD over EMR in treating early-stage stomach cancer. Four main databases have been searched, including EMBASE and published. The ROBINS-I tool suggested in the Cochrane Handbook has been applied to evaluate the quality of the chosen trials. It may better reflect the risk of bias in the included studies. The meta-analyses were carried out with ReMan 5.3, and the results were treated with endote. Seven cohort studies have been completed. Meta analysis indicated that EMR and ESD surgery did not differ significantly from each other in terms of postoperative haemorrhage (OR, 0.76; 95%CI, 0.56,1.04 p = 0.09); EMR, however, was associated with a lower rate of postoperative perforation than ESD surgery (OR, 0.36; 95%CI, 0.24,0.54 p < 0.0001). Taking into account that ESD and EMR did not differ significantly in the risk of wound bleeding, even though the risk of perforation is not likely to result in life-threatening illness. In the analysis of these data, however, the potential advantages of EMR might be greater than ESD.

Comparing efficacy and factors of postoperative bleeding in endoscopic mucosal resection vs coagulation for intestinal polyps.

This study aimed to assess the effectiveness of Endoscopic Mucosal Resection (EMR) and Argon Plasma Coagulation (APC) as therapeutic approaches for intestinal polyps in patients, and to examine the factors associated with postoperative bleeding. This study included 132 patients diagnosed with colorectal polyps (188 polyps) who underwent endoscopic surgery at our hospital between January 2022 and December 2022. Based on the surgical method employed, the patients were divided into 2 groups: EMR (68 cases, 97 polyps) and APC (64 cases, 91 polyps). Comparative analyses were conducted to assess the clinical efficacy, surgery-related indicators, and quality of life the 2 groups. Furthermore, an investigation was carried out to identify the factors associated with postoperative bleeding. The analysis revealed no statistically significant difference in the cure rate of flat and superficial raised polyps between the EMR group and the APC (P > .05). However, it was found that the EMR group exhibited a significantly higher cure rate for subpedunculated and raised-pedunculated polyps compared to the APC group (P < .05). The results of logistics analysis showed that patients with hypertension (OR = 2.876, 95% CI: 1.119-7.393), patients with diabetes (OR = 5.278, 95% CI: 1.388-20.064), patients with hyperlipidemia (OR = 2.594, 95% CI: 1.054-6.380), the polyps of right hemicolon (OR = 2.743, 95% CI: 1.003-7.504), rectal polyps (OR = 5.143, 95% CI: 1.728-7.504), pedunculated polyps (OR = 4.758, 95% CI: 1.322-17.129), adenomatous polyps (OR = 3.152, 95% CI: 1.018-9.757) were independent risk factors for postoperative bleeding in patients with colorectal polyps (P < .05). The findings suggest that for subpedunculated and pedunculated-raised polyps, EMR can be a suitable treatment approach. On the other hand, flat and superficial-raised polyps can be effectively managed with either EMR or APC. The presence of hypertension, diabetes, hyperlipidemia, polyps of the right hemicolon, rectal polyps, pedunculated polyps, and adenomatous polyps has been established as independent risk factors for postoperative bleeding in patients with colorectal polyps.

Is endoscopic mucosal resection-precutting superior to conventional methods for removing sessile colorectal polyps?

We reviewed a study that reported a comparative analysis of the effects of endoscopic mucosal resection (EMR) precutting and conventional EMR for removing non-pedunculated, 10-20 mm sized colorectal polyps. We identified some statistical deficiencies in this study. In addition, we believe that the differences between the treatments failed to achieve significance, and therefore, further analysis is required.

Safety and efficacy of a new cold snare technique with clipping for colorectal angioectasia.

Colorectal angioectasia is a major cause of lower gastrointestinal bleeding. Use of antithrombotic agents is expected to increase with aging of the population, and bleeding from angioectasia is an important issue. Although the effectiveness of endoscopic mucosal resection for colorectal angioectasia has been reported, there are no reports of cold snare technique for angioectasia (CSA). From February 2018 to February 2022, the safety of CSA was evaluated at Omori Red Cross Hospital. We investigated the incidence of bleeding (delayed post-polypectomy bleeding (DPPB) and immediate bleeding) after CSA and the incidence of rebleeding requiring repeated endoscopic treatment. During the study period, 106 angioectasias were identified during colonoscopy. We only targeted patients with bloody stools and/or anemia requiring treatment for bleeding from angioectasia. Finally, we included 11 angioectasias in this study. Rates of DPPB and rebleeding after CSA were 0 %. The rate of immediate bleeding during CSA was 27.3 % (3/11). Dilated capillaries could be observed pathologically in nine of 11 lesions (81.8 %). CSA was safe and can be a new treatment option in the future. To confirm our results and verify the long-term safety and efficacy of CSA, further studies are desirable.

S772 Endoscopic Mucosal Resection for Colorectal Dysplasia in Inflammatory Bowel Disease

Introduction: Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer due to underlying chronic inflammation. Frequent surveillance colonoscopy is essential for early identification and removal of dysplastic lesions in this group. Many dysplastic lesions in IBD require advanced endoscopic resection due to size, morphology, or indistinct margins. The effectiveness of endoscopic mucosal resection (EMR) for laterally spreading lesions is well documented in the general population; however, EMR continues to be challenging in patients with IBD. We aim to characterize outcomes of EMR for IBD-associated lesions compared to controls. Methods: Retrospective data was collected from 2016 to 2021. CPT code 45390 was used to identify colonoscopies with EMR. ICD-10 codes K50-52 were used to identify patients with IBD. Adenomatous and dysplastic lesions of all sizes that were removed with EMR and underwent endoscopic surveillance were included. Data was recorded and stored in a REDCap database and analyzed using a mixed effects model for logistic regression with SAS Statistical Software. Results: A total of 23 lesions in 14 patients with IBD and 187 lesions in 141 patients without IBD were included. Gender, ethnicity, age, lesion size and location, procedure date and duration, and number of lesions per patient were similar among both groups (Table). Piecemeal resection (as opposed to en bloc resection) was more common in the IBD group (91.3% vs. 42.1%, P< .001). Surgical resection was required for 2 IBD-associated lesions and 7 controls (8.7% vs. 3.9%, P=.27). Recurrence was detected and confirmed by histology in 7 IBD-associated lesions and 39 controls. In a mixed effects logistic regression model (Figure), IBD and lesion size were independently associated with recurrence (OR=3.08, 95% CI 1.04-9.13, P=.04; OR=1.06 per mm increase, 95% CI 1.02-1.09, P=.001). For each year that elapsed from the study start date to the procedure date, odds of recurrence decreased by 28% (OR=0.72, 95% CI 0.58-0.90, P=.004). In this model, 38.4% of IBD-associated lesions (95% CI 18.6-58.1) compared to 19.1% of controls (95% CI 13.8-24.5) recurred after EMR. Conclusion: Recurrence of dysplastic lesions after EMR is more common in patients with IBD compared to controls. Most IBD-associated lesions are resected piecemeal. EMR in patients with IBD should be performed in expert centers with close endoscopic surveillance.Figure 1.: Mixed effects logistic regression model estimating odds of recurrence after EMR of adenomatous and dysplastic colorectal lesions. Diagnosis of IBD, lesion size, year of procedure, and degree of dysplasia were incorporated in the model. OR = 3.08 with a diagnosis of IBD (95% CI 1.04-9.13, p=.04). OR = 1.06 with each millimeter increase in lesion diameter (95% CI 1.02-1.09, p=.001). OR = 0.72 with each year from the study start date that elapsed prior to EMR (95% CI 0.58-0.90, P=.004). Table 1. - Characteristics of adenomatous and dysplastic colorectal lesions resected with EMR in patients with IBD compared to controls Total n = 210 Control n = 187 IBD n = 23 P-value Lesion size (mm): mean (SD) 21.7 (12.2) 21.5 (12.4) 22.9 (11.3) .62 Degree of dysplasia: n (%) .81 adenoma/low-grade dysplasia 191 (91.0) 170 (90.9) 21 (91.3) high-grade dysplasia 14 (6.7) 12 (6.4) 2 (8.7) invasive carcinoma 5 (2.4) 5 (2.7) 0 (0.0) Location: n (%) .36 ascending colon 69 (35.8) 61 (35.3) 8 (40.0) transverse colon 44 (22.8) 40 (23.1) 4 (20.0) cecum 29 (15.0) 28 (16.2) 1 (5.0) sigmoid colon 19 (9.8) 18 (10.4) 1 (5.0) descending colon 14 (7.3) 12 (6.9) 2 (10.0) rectum 11 (5.7) 9 (5.2) 2 (10.0) ileocecal valve 7 (3.6) 5 (2.9) 2 (10.0) Procedure time (min): mean (SD) 74.1 (29.9) 73.3 (30.4) 80.6 (25.5) .27 En-bloc vs piecemeal resection: n (%) < .001 en-bloc 108 (52.4) 106 (57.9) 2 (8.7) piecemeal 98 (47.6) 77 (42.1) 21 (91.3) Complications: n (%) 11 (5.2) 9 (4.8) 2 (8.7) .34

Comparative Analysis of Clinical Effects of Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD) in the Treatment of Early Digestive Tract Tumors

Comparative Analysis of Clinical Effects of Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD) in the Treatment of Early Digestive Tract Tumors

SMALL AS WELL AS LARGE COLORECTAL LESIONS ARE EFFECTIVELY MANAGED BY ENDOSCOPIC MUCOSAL RESECTION TECHNIQUE.

Endoscopic mucosal resection (EMR) is an easy-to-use treatment option for superficial colorectal lesions, including lesions ≥20 mm. To evaluate the effectiveness of EMR. We evaluated 430 lesions removed by EMR in 404 patients. The lesions were analyzed according to their morphology, size, location, and histology. Lesions <20 mm were resected en bloc, whereas lesions ≥20 mm were removed by piecemeal EMR (p-EMR). Adverse events and recurrence were assessed. Regarding morphology, 145 (33.7%) were depressed lesions, 157 (36.5%) were polypoid lesions and 128 (29.8%) were laterally spreading lesions, with 361 (84%) lesions <20 mm and 69 (16%) ≥20 mm. Regarding histology, 413 (96%) lesions were classified as neoplastic lesions. Overall, 14 (3.3%) adverse reactions occurred, most commonly in lesions removed by p-EMR (P<0.001) and associated with advanced histology (P=0.008). Recurrence occurred in 14 (5.2%) cases, more commonly in lesions removed by p-EMR (P<0.001). EMR is an effective technique for the treatment of superficial colorectal lesions, even of large lesions.

Effectiveness of underwater endoscopic mucosal resection versus conventional endoscopic mucosal resection for 10 to 20 mm colorectal polyps: A protocol of systematic review and meta-analysis.

Background:Endoscopic mucosal resection (EMR) is a standard method commonly for removing 10 to 20 mm colorectal polyps. While the incidence of residual or recurrent after conventional EMR is remarkably high. Underwater endoscopic mucosal resection (UEMR) as an alternative technique to conventional EMR for removing colorectal polyps has high adenoma detection and complete resection rates, improves patient comfort, decreases sedation needs, eliminates the risks associated with submucosal injection, and reduces snare and diathermy-induced mucosal injury. We will conduct a comprehensive systematic review and meta-analysis to compare the effectiveness of these two therapies in the management of 10 to 20 mm colorectal polyps.Methods:PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database and Chinese Biomedical Literature Database will be searched from inception of databases to November 2020 without language limitation. Two reviewers will independently conduct article selection, data collection, and assessment of risk of bias. Any disagreement will be resolved by discussion with the third reviewer. Review Manager Software 5.3 will be used for meta-analysis. The Cochrane risk of bias tool will be used to assess the risk of bias.Results:This study will provide a systematic synthesis of current published data to compare the effectiveness of UEMR and conventional EMR for 10 to 20 mm colorectal polyps.Conclusions:This systematic review and meta-analysis will provide clinical evidence as to whether UEMR is more effective and safer than conventional EMR for 10 to 20 mm colorectal polyps.Study registration number:INPLASY2020100006.

S0361 Endoscopic Submucosal Dissection vs Endoscopic Mucosal Resection for the Treatment of Dysplastic Barrett's Esophagus and Adenocarcinoma

INTRODUCTION: Barrett’s associated non-invasive adenocarcinoma and dysplastic lesions are commonly treated with endoscopic mucosal resection (EMR). However, EMR may be associated with incomplete resection resulting in local recurrence. Endoscopic submucosal dissection (ESD) has been recognized as an alternative treatment with durable results and lower risk of recurrence. The aim of this study is to evaluate the comparative effectiveness of EMR to ESD for Barrett’s associated non-invasive adenocarcinoma and dysplastic lesions. METHODS: This was a single-center retrospective study of adult patients that underwent EMR and ESD for the treatment of dysplastic Barrett’s esophagus and non-invasive adenocarcinoma from 2015 to 2019. Baseline data was collected for age, gender, size of lesion, prior EMR, procedure times, and pathology. Cases with invasive cancers were excluded. Primary outcomes were en-bloc resection and margin negative (R0) rates. Secondary outcomes were procedure related adverse events (AEs), stricture formation, and recurrence rates. Statistical analyses were performed using Student’s t-test or Fisher’s exact test. A multivariable logistic regression was performed controlling for age, EMR or ESD, lesion size, and prior EMR to determine predictors for stricture formation. RESULTS: A total of 16 patients underwent ESD, 33 patients underwent EMR. Baseline patient, lesion, procedure characteristics and outcomes are summarized in Table 1. Mean size of lesions was larger for patients that underwent ESD compared to EMR (42.50 ± 18.26 vs 10.42 ± 6.57 mm; P < 0.001) with no difference in prior EMR attempts (P = 0.141). En bloc resection was achieved in 100% of ESD and 87.9% of EMR cases (P = 0.152) with higher R0 rate for ESD (100.00% vs 57.58%; P = 0.002). Procedure time was significantly shorter for EMR (46.32 ± 13.74 vs 83.94 ± 27.46 min; P < 0.001). Procedure-related AEs were similar between ESD and EMR (12.50%% vs 3.03%, P = 0.203); esophageal stricture was more common after ESD (P = 0.039). Curative resection rate was higher for ESD (100.00% vs 66.67%, P = 0.008) while local recurrence was more common after EMR (45.45% vs 0.00%; P < 0.001). On multivariable logistic regression, ESD was not a significant predictor of stricture formation after controlling for confounders. CONCLUSION: ESD is associated with a higher rate of complete resection and a lower rate of local recurrence compared to EMR in patients with Barrett’s associated non-invasive adenocarcinoma and dysplastic lesions even when controlling for lesion size.Table 1.: Patient Characteristics and Procedure-Related Outcomes

A167 MANAGEMENT OF LARGE COLORECTAL POLYPS IN NOVA SCOTIA

Abstract Background Colorectal cancer (CRC) has the third highest cancer incidence for males and females in Canada1. CRC rates are decreasing, likely due to implementation of CRC screening programs and removal of precancerous polyps. In Nova Scotia, management of large (&amp;gt; 2 cm) polyps is varied. Some patients are referred for endoscopic mucosal resection (EMR), while others referred for surgical resection. EMR is effective2 and associated with less morbidity and mortality compared to surgery3. Furthermore, EMR is less expensive than surgery and requires less resources when performed as a day procedure. Management of these polyps are unknown in Canada and are potentially changing with gathering evidence on the safety and effectiveness of EMR. North American and European guidelines recommend EMR for non-invasive colonic polyps as first line management. Aims This projects aim is to determine how large polyps are being treated in a group of FIT positive patients from Nova Scotia. Methods This is a retrospective observational study. The Nova Scotia Colon Cancer screening database was searched for FIT positive patients in 2017. Patients found to have &amp;gt; 2 cm colonic polyps were included. Malignant polyps were excluded. Electronic charts were reviewed to determine method of polyp removal. Endoscopic and histologic polyp information was obtained. Results 196 patients had at least one polyp &amp;gt; 2 cm. Within the central health zone where pathology results were available 78 patients had &amp;gt; 2cm polyps. 13 were excluded for malignancy, one lost to follow up and one patient was miscoded. In total 63 patients were included, 8 of which underwent a surgical resection. Of these surgically resected polyps the average size was 4 cm and 3 cm for the EMR group. The average time to removal was 3 months in the surgical group and one month in the EMR group. The average age was 68 years in the surgical group and 67 years in the EMR group. The endoscopists referring for surgery were 75% surgeon and 25% GI and the endoscopists performing EMR were 45% surgeon and 55% GI. 1 of 8 (12.5%) patients experienced complications (anastomotic leak) in the surgical group and 2 of 56 (3.6%) patients experienced post polypectomy bleeding in the EMR group. Conclusions In this study 12.5% of large nonmalignant polyps found in a group of FIT positive patients from Nova Scotia were removed surgically via resection. Polyps were on average larger by 1 cm in the surgical group and patients experienced a higher rate of complication. This study highlights the need for a structured system of referral and assessment for endoscopic removal of advanced polyps by expert endoscopists, to reduce the number of surgical resections. Additional investigation of additional years, and health zones outside the tertiary central health zone is ongoing. This will help provide more validity to our current data, and allow comparison of academic vs community management of large polyps. Funding Agencies None

Endoscopic submucosal dissection versus endoscopic mucosal resection for patients with early gastric cancer: a meta-analysis

ObjectivesTo investigate the treatment effects of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) for early gastric cancer (EGC).DesignMeta-analysis.MethodsWe systematically searched three electronic databases, including PubMed, EmBase and the...

Safety and effectiveness of endoscopic mucosal resection or endoscopic submucosal dissection for gastric neoplasia within 2 days’ hospital stay

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been well-established methods of treating upper gastrointestinal neoplasia. The aim of this study was to identify the safety and effectiveness of endoscopic treatment for gastric neoplasia within a 2-day hospital stay.Between 2004 and 2015, a total of 914 patients with gastric neoplasia were treated with EMR or ESD within 2 days of hospitalization. The neoplasia sites, en bloc resection rates, pathology, local residual neoplasia rates, and major complications were evaluated retrospectively.The mean age was 63.4 years old, and 636 (69.6%) patients were male. Adenoma was the most common final diagnosis (60.9%), followed by adenocarcinoma (28.9%). The first follow-up endoscopy was performed 4.9 ± 1.1 months after the procedure, and an average of 4.4 endoscopic examinations were performed for 7.16 years (range, 2.1 to 10.2 years). Additional surgery was performed in 11 (1.2%) cases based on post-procedure pathology results. On follow-up endoscopy, a mean of 5.9 months after the procedure, there were 18 residual neoplasia cases (EMR = 13, ESD = 5). Only 4 (0.4%) patients returned to the emergency unit with delayed bleeding, but all 4 cases were successfully controlled with endoscopic treatment. There were no other complications such as delayed perforation or aspiration pneumonia during the 2 days in hospital.EMR and ESD within only 2 days in hospital showed safe and effective outcomes in terms of managing early gastric neoplasia with low complication and local residual rates.

Clinical study of endoscopic mucosal resection for digestive tract early cancer and precancerous lesions treatment

&lt;p class="p1"&gt;The clinical effect of endoscopic mucosal resection (EMR) on the digestive tract of early cancer and precan-cerous lesions was analyzed. 63 patients with early gastrointestinal cancer and precancerous lesions treated in our hospital from January 2013 to May 2015 were recruited for this study. Patients were randomly divided into the observation group (32 cases) and the control group (31 cases). The control group underwent conventional surgical treatment, while the observation group underwent EMR. Both groups were observed for the clinical effect. The curative resection rate was 100.0% (P &amp;gt; 0.05). The postoperative complication rate was 3.1% (1/32) in the observation group and 25.8% (8/31) in the control group. The operation time for the observation group was significantly shorter than the control group (P &amp;lt; 0.05). Subjects were followed up for 1 year. Both groups showed no primary tumor metastasis and recurrence (P &amp;gt; 0.05). EMR treatment showed good effect and significantly fewer complications in patients. &lt;/p&gt;

Clinical study of endoscopic mucosal resection for digestive tract early cancer and precancerous lesions treatment

&lt;p class="p1"&gt;The clinical effect of endoscopic mucosal resection (EMR) on the digestive tract of early cancer and precan-cerous lesions was analyzed. 63 patients with early gastrointestinal cancer and precancerous lesions treated in our hospital from January 2013 to May 2015 were recruited for this study. Patients were randomly divided into the observation group (32 cases) and the control group (31 cases). The control group underwent conventional surgical treatment, while the observation group underwent EMR. Both groups were observed for the clinical effect. The curative resection rate was 100.0% (P &amp;gt; 0.05). The postoperative complication rate was 3.1% (1/32) in the observation group and 25.8% (8/31) in the control group. The operation time for the observation group was significantly shorter than the control group (P &amp;lt; 0.05). Subjects were followed up for 1 year. Both groups showed no primary tumor metastasis and recurrence (P &amp;gt; 0.05). EMR treatment showed good effect and significantly fewer complications in patients. &lt;/p&gt;

Su1629 Cost Effectiveness of Endoscopic Mucosal Resection Compared to Transanal Resection of Complex Rectal Polyps

Su1629 Cost Effectiveness of Endoscopic Mucosal Resection Compared to Transanal Resection of Complex Rectal Polyps

Sa1609 Predictors of Unsuccessful Endoscopic Mucosal Resection (EMR) of Complex Colon Polyps (Ccps): Results From a Large Multicenter US Study

The effectiveness and safety of EMR for removal of CCP (defined as ≥ 2 cm or flat/depressed) have been well established. Variable rates of residual adenoma after EMR have been described. There are limited data with regards to predictors of EMR technical failure (TF) and residual adenoma at first surveillance colonoscopy. Aims: 1. To evaluate predictors of TF of EMR and residual adenoma at first surveillance colonoscopy (primary)2. To define technical success (TS) rates and safety of EMR (secondary).

Endoscopic mucosal resection of large colorectal adenomas: Only for expert centers?

Endoscopic mucosal resection of large colorectal adenomas: Only for expert centers?

Efficacy and safety of endoscopic resection therapies for rectal carcinoid tumors: a meta-analysis.

PurposeSeveral endoscopic resection therapies have been applied for the treatment of rectal carcinoid tumors. However, there is currently no consensus regarding the optimal strategy. We performed a meta-analysis to compare the efficacy and safety of endoscopic mucosal resection (EMR) or modified EMR (m-EMR) versus endoscopic submucosal dissection (ESD) for the treatment of rectal carcinoid tumors.Materials and MethodsPubMed, Web of Science, Medline, Embase and CNKI were searched up to the end of January 2014 in order to identify all studies on the effects of EMR (or m-EMR) and ESD on rectal carcinoid tumors.ResultsA total of fourteen studies involving 782 patients were included. The pooled data suggested a significantly higher rate of pathological complete resection among patients treated with ESD or m-EMR than those treated with EMR [odds ratio (OR)=0.42, 95% confidence interval (CI): 0.25-0.71; OR=0.10, 95% CI: 0.03-0.33, respectively], while there was no significant difference between the m-EMR group and ESD group (OR=1.19, 95% CI: 0.49-2.86); The procedure time of ESD was longer than EMR or m-EMR groups [mean differences (MD)=-11.29, 95% CI: -14.19 - -8.38, MD= -10.90, 95% CI: -18.69 - -3.11, respectively], but it was insignificance between the EMR and m-EMR groups. No significant differences were detected among the treatment groups with regard to complications or recurrence.ConclusionThe results of this meta-analysis suggest that treatment of rectal carcinoid tumors with ESD or m-EMR is superior to EMR, and the efficacy of m-EMR is equivalence to ESD treatment. However, more well-designed studies are needed to confirm these findings.

Endoscopic mucosal resection of large rectal adenomas in the era of centralization: Results of a multicenter collaboration.

Endoscopic mucosal resection (EMR) of large rectal adenomas is largely being centralized. We assessed the safety and effectiveness of EMR in the rectum in a collaboration of 15 Dutch hospitals. Prospective, observational study of patients with rectal adenomas >3 cm, resected by piecemeal EMR. Endoscopic treatment of adenoma remnants at 3 months was considered part of the intervention strategy. Outcomes included recurrence after 6, 12 and 24 months and morbidity. Sixty-four patients (50% male, age 69 ± 11, 96% ASA 1/2) presented with 65 adenomas (diameter 46 ± 17 mm, distance ab ano 4.5 cm (IQR 1-8), 6% recurrent lesion). Sixty-two procedures (97%) were technically successful. Histopathology revealed invasive carcinoma in three patients (5%), who were excluded from effectiveness analyses. At 3 months' follow-up, 10 patients showed adenoma remnants. Recurrence was diagnosed in 16 patients during follow-up (recurrence rate 25%). Fifteen of 64 patients (23%) experienced 17 postprocedural complications. In a multicenter collaboration, EMR was feasible in 97% of patients. Recurrence and postprocedural morbidity rates were 25% and 23%. Our results demonstrate the outcomes of EMR in the absence of tertiary referral centers.