Efficacy, safety, and outcomes of endoscopic submucosal dissection for inflammatory bowel disease-associated colorectal neoplasia: a systematic review and meta-analysis comparing Asian and Western outcomes.

INTRODUCTION

Endoscopic submucosal dissection (ESD) is increasingly being adopted worldwide for the treatment of colorectal neoplasia. However, its role in patients with inflammatory bowel disease (IBD) remains debatable, due to chronic inflammation-related fibrosis, potentially affecting outcomes. This study aimed to assess the efficacy and safety of ESD for colorectal neoplastic lesions in IBD patients, comparing Asian and Western settings.

METHODS

A systematic review was conducted by searching MEDLINE and Web of Science until January 2025, in accordance to MOOSE guidelines. We included primary studies reporting ESD performance in IBD patients. We performed random-effects meta-analysis for several outcomes, including en-bloc, R0, and curative resection rates, frequency of adverse events (post-procedural bleeding and perforation), local recurrence, and need for additional surgery after ESD. Certainty of evidence was assessed using GRADE.

RESULTS

We included 20 studies (565 patients and 732 lesions). The meta-analytical frequencies of en-bloc, R0, and curative resection rates were 95.7% (95% CI = 93.5-97.9%; I2 = 60.1%), 84.6% (95% CI = 79.4-90.1%; I2 = 68.9%), and 83.9% (95% CI = 76.3-92.4%; I2 = 75.9%), respectively. Postprocedural bleeding and perforation occurred in 7.0% (95% CI = 4.4-11.2%; I2 = 16.9%) and 7.9% (95% CI = 5.3-11.9%; I2 = 2.4%) of cases, respectively. Local recurrence frequency was 5.3% (95% CI = 3.5-7.9%; I2 = 0%). The meta-analytical need for additional surgery was 13.3% (95% CI = 9.5-18.1%; I2 = 42.5%). No differences were found between Asian and Western studies for any outcome. The certainty of evidence was considered "low" in four outcomes and "very low" in the remaining outcomes.

CONCLUSION

ESD may be feasible and safe for treating IBD-associated colorectal neoplasias, but the available evidence is limited. Similar results were observed between Asian and Western studies.