Endoscopic mucosal resection with suction vs. endoscopic submucosal dissection for small rectal neuroendocrine tumors: a meta-analysis.

OBJECTIVE: There are no guidelines or consensus on the optimal treatment measures for small rectal neuroendocrine tumors (NETs) at present. This meta-analysis was conducted to compare the efficacy and safety of endoscopic mucosal resection (EMR) with suction and endoscopic submucosal dissection (ESD) for the small rectal NETs.

METHODS: The literature searches were conducted using Pubmed and Embase databases, and then a meta-analysis was performed. The primary outcome was complete resection rate, and the secondary outcomes were complication rate, procedure time, and recurrence rate.

RESULTS: Fourteen studies with 823 patients were included in our meta-analysis. The overall complete resection rates in EMR with suction and ESD procedure were 93.65% (472/504) and 84.08% (243/289), respectively. The pooled analysis showed that EMR with suction could achieve a higher complete resection rate than ESD with significance (OR: 4.08, 95% CI: 2.42-6.88, p < .00001) when the outlier study was excluded, and procedure time was significantly shorter in the EMR with suction group than in the ESD group (SMD: -1.59, 95% CI: -2.27 to -0.90, p < .00001). Moreover, there was no significant difference in overall complication rate (OR: 0.56, 95% CI: 0.28-1.14, p = .11) and overall recurrence rate (OR: 0.76, 95% CI: 0.11-5.07, I2 =48%) between EMR with suction and ESD group.

CONCLUSIONS: The present meta-analysis mostly based on retrospective studies show that EMR with suction is superior to ESD for small rectal NETs (≤10 mm) with higher complete resection rate, shorter procedure time, and similar overall complication rate and recurrence.