title: Comparing endoscopic mucosal resection with endoscopic submucosal dissection: the different endoscopic techniques for colorectal tumors.
abstract: BACKGROUND
  Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are used for the removal of colorectal tumors. There are no current guidelines or consensus on the optimal treatment strategy for these lesions. A meta-analysis was conducted to compare the effectiveness and safety of ESD and EMR for colorectal tumors.
  
  
  METHODS
  For the years 1966 until October 2014, Medline, PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were searched for articles comparing the effectiveness and safety of ESD and EMR. STATA 11.0 and RevMan 5.0 were used for meta-analysis and publication bias.
  
  
  RESULTS
  Seventeen articles were included in this meta-analysis. ESD was more effective than EMR in endoscopic complete resection rate (odds ratio [OR] = 2.81; 95% confidence interval [CI], 1.39-5.70; Z = 2.86; P = 0.004) and pathologic complete resection rate (OR = 2.81; 95% CI, 1.39-5.70; Z = 2.86; P = 0.004). ESD resulted in a higher perforation rate (OR = 5.27; 95% CI, 2.75-10.08; Z = 5.01; P < 0.00001) and a lower recurrence rate (OR = 0.14; 95% CI, 0.06-0.30; Z = 5.04; P < 0.00001). The tumor size was larger in the ESD group (OR = 3.09; 95% CI, 1.54-4.63; Z = 3.92; P < 0.0001), and the procedure time was longer in the ESD group (OR = 21.39; 95% CI, 10.33-32.46; Z = 3.79; P = 0.0002). But bleeding rate did not differ significantly (OR = 1.34; 95% CI, 0.81-2.20; Z = 1.14; P = 0.25). There was no publication bias analyzed by Begg test and Egger test.
  
  
  CONCLUSIONS
  The study indicates that ESD is the better treatment for colorectal tumors for its higher complete resection rate despite the longer procedure time and higher perforation rate.
authors.affiliation: Department of Family Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Guanqun
authors.initials: G
authors.lastname: Chao
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
authors.forename: Shuo
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Institution of Gastroenterology, Zhejiang University, Hangzhou, China. Electronic address: sijm@zju.edu.cn.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Si
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000236:Adenoma / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D016896:Treatment Outcome
keywords: Colorectal tumors; Endoscopic mucosal resection; Endoscopic submucosal dissection; Meta-analysis