title: Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: A systematic review.
abstract: OBJECTIVE
  To assess the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for the treatment of colorectal lesions.
  
  
  METHODS
  A literature search was conducted from January 2000 to May 2015. The main outcomes were: recurrence after "en bloc" and "piecemeal" resection; procedure related adverse events; the EMR endoscopic success rate and the completely eradicated resection rate (R0) after ESD.
  
  
  RESULTS
  A total of 66 studies were included in the analysis. The total number of lesions was 17950 (EMR: 11.873; ESD: 6077). Recurrence rate was higher in the EMR than ESD group (765/7303l vs. 50/3910 OR 8.19, 95% CI 6.2-10.9 p<0.0001). EMR-en bloc resection was achieved in 6793/10803 lesions (62.8%) while ESD-en bloc resection was obtained in 5500/6077 lesions (90.5%) (OR 0.18, p<0.0001, 95% CI 0.16-0.2). Perforation occurred more frequently in ESD than in EMR group (p<0.0001, OR 0.19, 95% CI 0.15-0.24).
  
  
  CONCLUSIONS
  Endoscopic resection of large colorectal lesions is safe and effective. Compared with EMR, ESD results in higher "en bloc" resection rate and lower local recurrence rate, however ESD has high procedure-related complication rates.
authors.affiliation: Gastroenterology Department, General Hospital, Sanremo, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: De Ceglie
authors.affiliation: Gastroenterology Department, Nuovo Regina Margherita Hospital, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Gastroenterology Department, General Hospital, Sanremo, Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Mangiavillano
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Matsuda
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Gastroenterology Unit, "Sapienza" University, Rome, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ridola
authors.affiliation: Gastroenterology Department, Portsmouth Hospital NHS Trust, Portsmouth, Hampshire, UK.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bhandari
authors.affiliation: Gastroenterology Department, General Hospital, Sanremo, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Boeri
authors.affiliation: Gastroenterology Department, General Hospital, Sanremo, Italy. Electronic address: mxconio@tin.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Conio
mesh_terms: D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000601:surgery*; D000069916:Endoscopic Mucosal Resection; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D012307:Risk Factors
keywords: Colorectal lesion; EMR; ESD; LST; endoscopic mucosa resection; endoscopic submucosal dissection; laterally spreading tumor