Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver · 2026
Modified endoscopic mucosal resection versus endoscopic submucosal dissection for rectal neuroendocrine tumors ≤10 mm: a systematic review and meta-analysis of randomized controlled trials.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод в очереди
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Pang Ke, Ying Lujing, Xu Hemiao, Wang Yabing, Chen Wangyang, Yang Daiyu, Xiao Qiming, Li Shuai, Li Rutong, Wang Hongwei, Gao Jingchao, Zhang Peiyu, Li Jun, He Kun, Wang Qiang, Wu Dong
Аннотация
BACKGROUND: Endoscopic resection is the standard treatment for rectal neuroendocrine tumors (r-NETs) ≤10 mm, yet the optimal technique remains debated. Modified endoscopic mucosal resection (m-EMR) has been proposed as an alternative to endoscopic submucosal dissection (ESD), but prior evidence is mainly retrospective and recent randomized controlled trials (RCTs) are inconclusive.
METHODS: We systematically searched CENTRAL, PubMed, Embase, and WanFang from January 1, 1970 to December 23, 2025, for RCTs comparing m-EMR and ESD in r-NETs ≤10 mm. Evidence certainty was evaluated using GRADE, and trial sequential analysis (TSA) was conducted to support the statistical stability of the pooled estimate.
RESULTS: Six RCTs involving 440 patients were included. No significant differences were found between m-EMR and ESD in histologic complete resection (RR = 1.00, 95% CI 0.97-1.03; I² = 0%), en bloc resection (P = 0.75), or procedure-related adverse events (P = 0.94). m-EMR was associated with significantly shorter procedure time and lower hospitalization cost. Evidence certainty was moderate; TSA confirmed the reliability of the findings, and both cumulative and sensitivity analyses supported the robustness.
CONCLUSION: m-EMR provides comparable short-term histologic efficacy to ESD, while being associated with shorter procedure time and lower hospitalization costs, supporting its consideration as a reasonable first-line option for r-NETs ≤10 mm.
METHODS: We systematically searched CENTRAL, PubMed, Embase, and WanFang from January 1, 1970 to December 23, 2025, for RCTs comparing m-EMR and ESD in r-NETs ≤10 mm. Evidence certainty was evaluated using GRADE, and trial sequential analysis (TSA) was conducted to support the statistical stability of the pooled estimate.
RESULTS: Six RCTs involving 440 patients were included. No significant differences were found between m-EMR and ESD in histologic complete resection (RR = 1.00, 95% CI 0.97-1.03; I² = 0%), en bloc resection (P = 0.75), or procedure-related adverse events (P = 0.94). m-EMR was associated with significantly shorter procedure time and lower hospitalization cost. Evidence certainty was moderate; TSA confirmed the reliability of the findings, and both cumulative and sensitivity analyses supported the robustness.
CONCLUSION: m-EMR provides comparable short-term histologic efficacy to ESD, while being associated with shorter procedure time and lower hospitalization costs, supporting its consideration as a reasonable first-line option for r-NETs ≤10 mm.