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, I-2=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 (10mm) with higher complete resection rate, shorter procedure time, and similar overall complication rate and recurrence.