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Article Abstract
Background: Early-stage colorectal lesions are traditionally managed with conventional endoscopic mucosal resection (EMR-C). Endoscopic submucosal dissection (ESD), though technically demanding, enables en bloc resection with negative margins. Precut mucosectomy (EMR-P) was developed to enhance en bloc resection rates by minimizing the risk of snare slippage during procedures.
Methods: A systematic review and meta-analysis of cohort studies and randomized controlled trials (RCTs) compared EMR-P with EMR-C, ESD, and Hybrid ESD (ESD-H). Databases were queried for studies reporting en bloc resection rate and complete histological resection rate (R0), as well outcomes including procedure time, recurrence rate, and adverse events. Risk ratios (RRs) and weighted mean differences with 95% confidence intervals (CIs) were calculated using random or fixed-effects models based on heterogeneity.
Results: Twelve studies, including 2.575 lesions (921 EMR-P, 615 EMR-C, 955 ESD, 84 ESD-H), were analyzed. EMR-P outperformed EMR-C in en bloc resection rates (RR 1.17, 95% CI: 1.03-1.33; P = 0.01) and R0 resection rates (RR 1.34, 95% CI: 1.15-1.57; P = 0.0002), particularly for flat lesions in the right colon. However, EMR-P was associated with a higher rate of adverse events. Compared to ESD, EMR-P demonstrated lower en bloc resection rate (RR 0.85; 95% CI; 0.75-0.97, P = 0.02) but showed no significant difference R0 resection rate (RR 0.95, 95% CI, 0.88-1.02, P = 0.15). In head-to-head comparisons between EMR-P and ESD-H, no significant differences were observed in en bloc or complete resection rates.
Conclusion: EMR-P emerges as a promising technique for resecting flat colorectal lesions > 10 mm, particularly those in the right colon, by reducing the risk of snare slippage. Future RCTs are essential to establish EMR-P's role in managing large colorectal neoplasms and optimizing recurrence prevention strategies.
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