Endoscopic mucosal resection vs endoscopic submucosal dissection for rectal carcinoid tumours: a systematic review and meta-analysis.
OBJECTIVE
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are used for the removal of rectal carcinoid tumours. There are no current guidelines or consensus on the optimal treatment strategy for these lesions. A systematic review was conducted to compare the efficacy and safety of ESD and EMR.


METHODS
The generation of inclusion criteria and analysis of data were based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. A systematic literature review was conducted using the following databases: Medline, Embase, SpringerLink, Elsevier ScienceDirect, Science Citation Index and the Cochrane Library. Only papers comparing treatment of rectal carcinoid tumours by EMR and by ESD were selected. The data collected included the patients' demographic information, interventions made, observed outcome and sources of bias.


RESULTS
Four papers were included in this systematic review and meta-analysis. ESD was more effective than EMR in complete resection (OR 0.29; 95% CI 0.14-0.58; P = 0.000). ESD was as safe as EMR [rate difference (RD) -0.01; 95% CI -0.07 to 0.05; P = 0.675]. Recurrence rates did not differ significantly between the EMR and ESD groups (RD 0.04; 95% CI -0.01 to 0.09; P = 0.150). The duration of ESD was longer than EMR (standardized mean difference -1.73; 95% CI -2.73 to -0.74; P = 0.001).


CONCLUSIONS
The study indicates that ESD is the better treatment for rectal carcinoid tumours.
Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
D-D
DD
Zhong
L-M
LM
Shao
J-T
JT
Cai
D002276:Carcinoid Tumor / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D007414:Intestinal Neoplasms / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome