P3626 - Precutting Endoscopic Mucosal Resection Compared to Conventional Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection for Colorectal Neoplasia: A Systematic Review and Meta-Analysis
Indiana University School of Medicine Indianapolis, IN
Azizullah Beran, MD1, Tarek G. Aridi, MD1, Mohammad Bilal, MD2, John M. DeWitt, MD, FACG1, Mohammad Al-Haddad, MD, FACG1, John Guardiola, MD1 1Indiana University School of Medicine, Indianapolis, IN; 2University of Minnesota and Minneapolis VA Health Care System, Minneapolis, MN
Introduction: Endoscopic submucosal dissection (ESD) is superior to piecemeal endoscopic mucosal resection (PM-EMR) for curative resection of colorectal neoplasia but involves longer procedures and higher risks and costs. Precutting EMR (PC-EMR), which involves a circumferential incision before mucosal resection, may improve curative resection rates over PM-EMR with lower risks and costs than ESD.
Methods: We searched PubMed, Embase, and Web of Science databases through February 2024 for all studies that compared the outcomes of PC-EMR with PM-EMR and/or ESD for colorectal neoplasia. Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CIs) were obtained using a random-effect model. The primary outcomes were en-bloc resection and complete resection rates. Complete resection was defined as en-bloc resection with negative histological negative margins. Secondary outcomes were procedure time, bleeding, and perforation rates.
Results: Out of 223 studies screened, nine studies with 2,136 patients and 2,170 neoplastic lesions (PC-EMR=652, PM-EMR= 906, and ESD=612) were included. Of 2,170 neoplastic lesions, 76% were adenomas. Compared to PM-EMR, PC-EMR was associated with higher en-bloc resection (RR 1.18, 95% CI 1.03-1.36, P=0.02, I2=74%, Figure 1) and complete resection (RR 1.17, CI 1.01-1.37, P=0.04, I2=68%, Figure 1), but had higher perforation (RR 3.47, CI 1.35-8.96, P=0.01, I2=0%, Figure 1) and longer procedure time (MD 11.63 minutes; CI 5.73, 17.54; P< 0.001, I2=97%) and similar bleeding risks (RR 1.23, CI 0.51-2.98, P=0.64, I2=61%). Compared to ESD, PC-EMR had comparable en-bloc resection (RR 0.82, CI 0.63-1.07, P=0.15, I2=98%, Figure 1), complete resection (RR 0.88, CI 0.73-1.05, P=0.16, I2=90%, Figure 1), bleeding (RR 2.13, CI 0.48-9.51, P=0.32, I2=16%), perforation (RR 0.57, CI 0.21-1.50, P=0.25, I2=50%, Figure 1), but had shorter procedure times (MD -25.21 minutes; CI -33.32, -17.10; P< 0.001, I2=84%).
Discussion: PC-EMR was associated with higher en-bloc and complete resection than PM-EMR but at the cost of higher perforation rates and longer procedure times, but similar bleeding rates. PC-EMR was non-inferior to ESD in en-bloc and complete resections, had shorter procedure times and comparable bleeding and perforation rates to ESD. PC-EMR may be a promising technique that bridges PM-EMR and ESD for the resection of colorectal neoplasia. Further RCTs are needed to validate our findings.
Figure: Compared to PM-EMR, PC-EMR was associated with higher en-bloc resection and complete resection but had higher perforation and longer procedure time and similar bleeding risks. Compared to ESD, PC-EMR had comparable en-bloc resection and complete resection, bleeding and perforation risks, but had shorter procedure times.
Disclosures:
Azizullah Beran indicated no relevant financial relationships.
Tarek Aridi indicated no relevant financial relationships.
Mohammad Bilal: Boston Scientific – Consultant. Cook endoscopy – Speakers Bureau.
John DeWitt indicated no relevant financial relationships.
Mohammad Al-Haddad: Amplified Sciences – Grant/Research Support. Boston Scientific – Consultant. Interpace Diagnostics – Consultant.
John Guardiola: Boston Scientific Corporation – Travel Support. Olympus Corporation – Travel Support.
Azizullah Beran, MD1, Tarek G. Aridi, MD1, Mohammad Bilal, MD2, John M. DeWitt, MD, FACG1, Mohammad Al-Haddad, MD, FACG1, John Guardiola, MD1. P3626 - Precutting Endoscopic Mucosal Resection Compared to Conventional Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection for Colorectal Neoplasia: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
