Meta-analysis and systematic review of colorectal endoscopic mucosal resection.
OBJECTIVE
To evaluate the proportion of successful complete cure en-bloc resections of large colorectal polyps achieved by endoscopic mucosal resection (EMR).


METHODS
Studies using the EMR technique to resect large colorectal polyps were selected. Successful complete cure en-bloc resection was defined as one piece margin-free polyp resection. Articles were searched for in Medline, Pubmed, and the Cochrane Control Trial Registry, among other sources.


RESULTS
An initial search identified 2620 reference articles, from which 429 relevant articles were selected and reviewed. Data was extracted from 25 studies (n = 5221) which met the inclusion criteria. All the studies used snares to perform EMR. Pooled proportion of en-bloc resections using a random effect model was 62.85% (95% CI: 51.50-73.52). The pooled proportion for complete cure en-bloc resections using a random effect model was 58.66% (95% CI: 47.14-69.71). With higher patient load (> 200 patients), this complete cure en-bloc resection rate improves from 44.19% (95% CI: 24.31-65.09) to 69.17% (95% CI: 51.11-84.61).


CONCLUSIONS
EMR is an effective technique for the resection of large colorectal polyps and offers an alternative to surgery.
Puli
Srinivas R
SR
Division of Gastroenterology, University of Missouri-Columbia, Columbia, MO 65212, United States of America.
Kakugawa
Yasuo
Y
Gotoda
Takuji
T
Antillon
Daphne
D
Saito
Yutaka
Y
Antillon
Mainor R
MR
D003111:Colonic Polyps / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D011230:Precancerous Conditions / Q000601:surgery*