Endoscopic submucosal dissection versus endoscopic mucosal resection for the treatment of rectal tumors extending to the dentate line: a systematic review and meta-analysis.

PURPOSE: We performed a systematic review and meta-analysis to compare the efficacy and safety of endoscopic submucosal dissection (ESD) with those of endoscopic mucosal resection (EMR) for rectal tumors extending to the dentate line (RTDLs).

METHODS

We searched the PubMed, Embase, Web of Science and the Cochrane Library databases up to July 2025 for studies that reported the clinical outcomes of EMR or ESD for RTDLs.

RESULTS

Fifteen studies (237 for EMR and 564 for ESD) were included in this meta-analysis. The en bloc resection rate (0.961 vs. 0.097; p = 0.000) was significantly greater in the ESD group than in the EMR group, and the local recurrence rate (0.023 vs. 0.188; p = 0.000) was significantly lower in the ESD group. No significant differences in the complete resection rate (0.793 vs. 0.823, p = 0.869) were noted between the ESD and EMR groups. In terms of adverse events, there were no differences in the postoperative bleeding rate (0.067 vs. 0.082; p = 0.677), perforation rate (0 vs.0; p = 0.605) or stricture rate (0.022 vs. 0.042; p = 0.378) between the ESD and EMR groups.

CONCLUSION

ESD and EMR are effective and safe treatments for RTDLs; however, compared with EMR, ESD is associated with a higher en bloc resection rate and a lower local recurrence rate.