S407 Comparative Efficacy of Precut Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection for Colorectal Polyps: A Systematic Review and Meta-Analysis

Introduction: Endoscopic submucosal dissection (ESD) is effective in the management of large colorectal polyps. However, ESD is technically demanding and time consuming. Precut EMR (EMR-P) is a modified EMR method that overcomes some of the limitations of EMR. It involves creating a circumferential mucosal incision around the lesion before resection. We conducted a meta-analysis to compare the outcomes of ERM-P with ESD in the management of colorectal polyps. Methods: Several databases were reviewed to identify studies comparing outcomes of ERM-P and ESD for colorectal polyps from inception to November 08, 2024. The databases searched included PubMed, Web of Science Core Collection, Embase, and the Cochrane Database of Systematic Reviews. Our outcomes of interest were en block resection, complete resection, local recurrence, delayed perforation, delayed bleeding, and procedure time. Subgroup analysis were performed for ≥20 mm polyps. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for all 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. Publication bias was assessed by funnel plots and Egger’s test. Results: Four studies comprising 870 patients (289 patients in ERM-P and 581 in ESD groups) met the inclusion criteria. We found no significant difference in rates of en block resection, RR (95% CI): 0.72 (0.46, 1.11), P = 0.13, complete resection RR (95% CI): 0.85 (0.66, 1.11), P = 0.23 and local recurrence, RR (95% CI): 1.21 (0.07, 21.85), P = 0.90 between groups. There was no significant difference in rate of adverse events between groups such as, delayed bleeding, RR (95% CI): 0.82 (0.21, 3.10), P = 0.76 and delayed perforation RR (95% CI): 0.78 (0.24, 2.54), P = 0.69. ERM-P was associated with shorter procedure time compared to ESD, MD (95% CI): -27.47 (-31.61, -23.33), P < 0.00001. Subgroup analysis for ≥20 mm polyps also showed no significant difference in rates of en block resection RR (95% CI): 0.73 (0.42, 1.27), P = 0.27, delayed bleeding, RR (95% CI): 0.99 (0.13, 7.42), P = 0.99, and delayed perforation RR (95% CI): 0.49 (0.20, 1.21), P = 0.12 between groups. Conclusion: Our meta-analysis found that, the outcomes of ERM-P were comparable to ESD for colorectal polyps, except procedure time which was shorter with EMR-P. Future large, multicentre studies are required to further evaluate these findings.