title: Colorectal endoscopic submucosal dissection: a systematic review and meta-analysis.
abstract: Background and study aims:Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique that allows en-bloc resection of gastrointestinal tumor. We systematically review the medical literature in order to evaluate the safety and efficacy of colorectal ESD.Patients and methods:We performed a comprehensive literature search of MEDLINE, EMBASE, Ovid, CINAHL, and Cochrane for studies reporting on the clinical efficacy and safety profile of colorectal ESD.Results:Included in this study were 13833 tumors in 13603 patients (42 % female) who underwent colorectal ESD between 1998 and 2014. The R0 resection rate was 83 % (95 % CI, 80 - 86 %) with significant between-study heterogeneity (P< 0.001) which was partly explained by difference in continent (P= 0.004), study design (P= 0.04), duration of the procedure (P= 0.009), and, marginally, by average tumor size (P= 0.09). Endoscopic en bloc and curative resection rates were 92 % (95 % CI, 90 - 94 %) and 86 % (95 % CI, 80 - 90 %), respectively. The rates of immediate and delayed perforation were 4.2 % (95 % CI, 3.5 - 5.0 %) and 0.22 % (95 % CI, 0.11 - 0.46 %), respectively, while rates of immediate and delayed major bleeding were 0.75 % (95 % CI, 0.31 - 1.8 %) and 2.1 % (95 % CI, 1.6 - 2.6 %). After an average postoperative follow up of 19 months, the rate of tumor recurrence was 0.04 % (95 % CI, 0.01 - 0.31) among those with R0 resection and 3.6 % (95 % CI, 1.4 - 8.8 %) among those without R0 resection. Overall, irrespective of the resection status, recurrence rate was 1.0 % (95 % CI, 0.42 - 2.1 %).Conclusions:Our meta-analysis, the largest and most comprehensive assessment of colorectal ESD to date, showed that colorectal ESD is safe and effective for colorectal tumors and warrants consideration as first-line therapy when an expert operator is available.
authors.affiliation: Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Akintoye
authors.affiliation: Developmental Endoscopy Lab, Brigham and Women's Hospital, Boston, Massachusetts, United States.
authors.forename: Nitin
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, United States.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Aihara
authors.affiliation: Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States.
authors.forename: Hala
authors.initials: H
authors.lastname: Nas
authors.affiliation: Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, United States.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Thompson