S408 Comparative Efficacy and Safety of Precut and Conventional Endoscopic Mucosal Resection in the Management of Colorectal Polyps: A Systematic Review and Meta-Analysis

Introduction: Endoscopic mucosal resection (EMR) is widely used for resection of sessile colorectal polyps. However, for larger polyps, the piecemeal resection rate is high which is a well-known risk factor for recurrence. Few studies have evaluated the efficacy and safety of Precut EMR (EMR-P), which involves creating a circumferential mucosal incision around the lesion before resection. We conducted a meta-analysis to compare the outcomes of ERM-P with conventional endoscopic mucosal resection (CEMR) in the management of colorectal polyps. Methods: Several databases included PubMed, Web of Science, Embase, and the Cochrane were reviewed to identify studies comparing outcomes of ERM-P and CEMR for colorectal polyps from inception to November 08, 2024. Our outcomes of interest were en block resection, complete resection, local recurrence, delayed perforation, delayed bleeding, and procedure time. Subgroup analyses were performed for three 20 mm polyps. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for categorical variables and mean differences with 95% CI for continuous variables. Data was analyzed using random effect model. Heterogeneity was assessed using the I2 statistic. Results: Six studies comprising 1,084 patients (467 in ERM-P group and 617 in CEMR group) met the inclusion criteria. We found no significant difference in rate of en block resection, RR (95% CI): 1.15 (0.99, 1.34), P= 0.07 and complete resection, RR (95% CI): 0.94 (0.52, 1.70), P= 0.85 between groups. There was no significant difference in rate of recurrence, RR (95% CI): 0.35 (0.11, 1.05), P= 0.06 and delayed bleeding, RR (95% CI): 0.69 (0.18, 2.59), P= 0.59 between groups. ERM-P was associated with significantly longer procedure time, MD (95% CI: 10.35 (5.30, 15.41), P < 0.0001 and higher risk of delayed perforation, RR (95% CI): 3.83 (1.35, 10.90), P= 0.01 compared to CEMR. Subgroup analysis that included >20 mm polyps found that, ERM-P was associated with higher rates of en block resection, RR (95% CI): 1.62 (1.34, 1.96), P < 0.00001, and complete resection, RR (95% CI): 1.72 (1.37, 2.17), P < 0.00001, compared to CEMR. Conclusion: Our meta-analysis demonstrates comparable efficacy and safety between ERM-P and CEMR for colorectal polyps, with ERM-P offering superior outcomes for polyps ≥20 mm. However, ERM-P is associated with longer procedure times and a higher risk of delayed perforation. Future large multicenter studies are needed to validate these findings.