Meta-Analysis of Endoscopic Full-Thickness Resection Versus Endoscopic Submucosal Dissection for Complex Colorectal Lesions

Sahib Singh; Babu P Mohan; Rakesh Vinayek; Sudhir Dutta; Dushyant S Dahiya; Manesh K Gangwani; Vishnu C Suresh Kumar; Ganesh Aswath; Ishfaq Bhat; Sumant Inamdar; Neil Sharma; Douglas G Adler

doi:10.1097/MCG.0000000000001996

Meta-Analysis of Endoscopic Full-Thickness Resection Versus Endoscopic Submucosal Dissection for Complex Colorectal Lesions

J Clin Gastroenterol. 2024 Apr 1. doi: 10.1097/MCG.0000000000001996. Online ahead of print.

Authors

Affiliations

¹ Departments of Internal Medicine.
² Department of Gastroenterology and Hepatology, Orlando Gastroenterology PA, Orlando, FL.
³ Gastroenterology and Hepatology, Sinai Hospital of Baltimore, Baltimore, MD.
⁴ Department of Gastroenterology and Hepatology, The University of Kansas School of Medicine, Kansas City, KS.
⁵ Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR.
⁶ Department of Gastroenterology and Hepatology, State University of New York Upstate Medical University, Syracuse, NY.
⁷ Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE.
⁸ Department of Gastroenterology and Hepatology, Parkview Health, Fort Wayne, IN.
⁹ Department of Gastroenterology and Hepatology, Centura Health at Porter Adventist Hospital, Denver, CO.

PMID: 38567896
DOI: 10.1097/MCG.0000000000001996

Abstract

Background: Studies evaluating endoscopic full-thickness resection (EFTR) and endoscopic submucosal dissection (ESD) for complex colorectal lesions have shown variable results. We conducted a meta-analysis of the available data.

Methods: Online databases were searched for studies comparing EFTR versus ESD for complex colorectal lesions. The outcomes of interest were resection rates, procedure time (min), and complications. Pooled odds ratios (OR) and standardized mean difference (SMD) along with 95% CI were calculated.

Results: A total of 4 studies with 530 patients (n=215 EFTR, n=315 ESD) were included. The mean follow-up duration was 5 months. The mean age of the patients was 68 years and 64% were men. The EFTR and ESD groups had similar rates of en bloc resection (OR: 1.73, 95% CI: 0.60-4.97, P=0.31) and R0 resection (OR: 1.52, 95% CI: 0.55-4.14, P=0.42). The EFTR group had significantly reduced procedure time (SMD -1.87, 95% CI: -3.13 to -0.61, P=0.004), total complications (OR: 0.24, 95% CI: 0.13-0.44, P<0.00001), perforation (OR: 0.12, 95% CI: 0.03-0.39, P=0.0005) and postresection electrocoagulation syndrome (OR: 0.06, 95% CI: 0.01-0.48, P=0.008). Delayed bleeding was similar in the 2 groups (OR: 0.80, 95% CI: 0.30-2.12, P=0.66). Residual/recurrent lesions were significantly higher in the EFTR group (OR: 4.67, 95% CI: 1.39-15.66, P=0.01).

Discussion: This meta-analysis of small studies with high heterogeneity showed that EFTR and ESD have comparable resection rates for complex colorectal lesions. EFTR is faster and has fewer complications, but it increases residual or recurrent lesions.