Comparison of precut endoscopic mucosal resection and endoscopic submucosal dissection in the management of colorectal polyps: a systematic review and meta-analysis

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BACKGROUND: Studies comparing precut endoscopic mucosal resection (EMR-P) and endoscopic submucosal dissection (ESD) for the management of colorectal polyps have reported conflicting results. In this meta-analysis, we have compared outcomes of EMR-P and ESD. METHODS: Several databases were reviewed from inception to 15 December 2024 to identify studies comparing EMR-P and ESD for colorectal polyps. Our outcomes of interest were en bloc and complete histologic resection, procedure time, perforation, and bleeding. For the outcomes of en bloc and complete histologic resection, we performed subgroup analyses including greater than or equal to 20 mm polyps and 20-30 mm polyps. We calculated the pooled odds ratio (OR) with 95% confidence intervals (CIs) for categorical variables and mean difference with 95% CI for continuous variables. RESULTS: We included nine studies comprising 1460 patients. The rate of en bloc resection was significantly lower in the EMR-P group (OR: 0.15, 95% CI: 0.09-0.23). The rate of complete histologic resection was significantly lower in the EMR-P group (OR: 0.50, 95% CI: 0.26-0.94). There was no significant difference in rates of en bloc and complete histologic resection between groups for 20-30 mm polyps. Procedure time was significantly shorter in the EMR-P group (Mean difference [MD]: -29.05, 95% CI: -37.04 to -21.06). There was no significant difference in adverse events such as bleeding and perforation between groups. CONCLUSION: Our meta-analysis demonstrates the superiority of ESD over EMR-P in achieving higher rates of en bloc and complete resection for colorectal polyps without increasing the risk of adverse events except for 20-30 mm polyps, where the outcomes were comparable between groups.

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