Skip to main content
SpringerLink
Log in

Endoscopic submucosal dissection (ESD) versus transanal endoscopic microsurgery (TEM) for treatment of rectal tumors: a comparative systematic review and meta-analysis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

While multiple studies have evaluated endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) to remove large rectal tumors, there remains a paucity of data to evaluate their comparative efficacy and safety. The primary aim of this study was to perform a structured systematic review and meta-analysis to compare efficacy and safety of ESD versus TEM for the treatment of rectal tumors.

Methods

Individualized search strategies were developed from inception through November 2018 in accordance with PRISMA guidelines. Measured outcomes included pooled enbloc resection rates, margin-negative (R0) resection rates, procedure-associated adverse events, and rates of recurrence. This was a cumulative meta-analysis performed by calculating pooled proportions. Heterogeneity was assessed with Cochran Q test and I2 statistics, and publication bias by funnel plot using Egger and Begg tests.

Results

Three studies (n = 158 patients; 55.22% male) were included in this meta-analysis. Patients with ESD compared to TEM had similar age (P = 0.090), rectal tumor size (P = 0.108), and diagnosis rate of adenoma to cancer (P = 0.53). ESD lesions were more proximal as compared to TEM (8.41 ± 3.49 vs. 5.11 ± 1.43 cm from the anal verge; P < 0.001). Procedure time and hospital stay were shorter for ESD compared to TEM [(79.78 ± 24.45 vs. 116.61 ± 19.35 min; P < 0.001) and (3.99 ± 0.32 vs. 5.83 ± 0.94 days; P < 0.001), respectively]. No significant differences between enbloc resection rates [OR 0.98 (95% CI 0.22–4.33); P = 0.98; I2 = 0.00%] and R0 resection rates [OR 1.16 (95% CI 0.36–3.76); P = 0.80; I2 = 0.00%] were noted between ESD and TEM. ESD and TEM reported similar rates of adverse events [OR 1.15 (95% CI 0.47–2.77); P = 0.80; I2 = 0.00%] and rates of recurrence [OR 0.46 (95% CI 0.07–3.14); P = 0.43; I2 = 0.00%].

Conclusion

ESD and TEM possess similar rates of resection, adverse events, and recurrence for patients with large rectal tumors; however, ESD is associated with significantly shorter procedure times and duration of hospitalization. Future studies are needed to evaluate healthcare utilization for these two strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69:7–34

    Google Scholar 

  2. Park SU, Min YW, Shin JU et al (2012) Endoscopic submucosal dissection or transanal endoscopic microsurgery for nonpolypoid rectal high grade dysplasia and submucosa-invading rectal cancer. Endoscopy 44:1031–1036

    Article  CAS  Google Scholar 

  3. Park HW, Byeon JS, Park YS et al (2010) Endoscopic submucosal dissection for treatment of rectal carcinoid tumors. Gastrointest Endosc 72:143–149

    Article  Google Scholar 

  4. Nam MJ, Sohn DK, Hong CW et al (2015) Cost comparison between endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumors. Ann Surg Treat Res 89:202–207

    Article  Google Scholar 

  5. Repici A, Hassan C, De Paula Pessoa D et al (2012) Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia: a systematic review. Endoscopy 44:137–150

    Article  CAS  Google Scholar 

  6. Guerrieri M, Baldarelli M, de Sanctis A, Campagnacci R, Rimini M, Lezoche E (2010) Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years’ experience. Surg Endosc 24:445–449

    Article  Google Scholar 

  7. Kunitake H, Abbas MA (2012) Transanal endoscopic microsurgery for rectal tumors: a review. Perm J 16:45–50

    Article  Google Scholar 

  8. Kawaguti FS, Nahas CS, Marques CF et al (2014) Endoscopic submucosal dissection versus transanal endoscopic microsurgery for the treatment of early rectal cancer. Surg Endosc 28:1173–1179

    Article  Google Scholar 

  9. Jung Y, Lee J, Cho JY et al (2018) Comparison of efficacy and safety between endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumor. Saudi J Gastroenterol 24:115–121

    Article  Google Scholar 

  10. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151:W65–W94

    Article  Google Scholar 

  11. Sterne JA, Hernan MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919

    Article  Google Scholar 

  12. Wells G, Shea B et al (2000) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. In: 3rd symposium on systematic reviews: beyond the basics; July 3–5; Oxford. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 18 Dec 2018

  13. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  Google Scholar 

  14. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  CAS  Google Scholar 

  15. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  Google Scholar 

  16. Stuart A, Ord JK (1994) Kendall’s advanced theory of statistics, 6th edn. Edward Arnold, London

    Google Scholar 

  17. Suzuki H, Furukawa K, Kan H et al (2005) The role of transanal endoscopic microsurgery for rectal tumors. J Nippon Med Sch 72:278–284

    Article  Google Scholar 

  18. Tanaka S, Toyonaga T, Morita Y et al (2016) Feasibility and safety of endoscopic submucosal dissection for lower rectal tumors with hemorrhoids. World J Gastroenterol 22:6268–6275

    Article  Google Scholar 

  19. Arezzo A, Passera R, Saito Y et al (2014) Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions. Surg Endosc 28:427–438

    Article  Google Scholar 

  20. Saito Y, Sakamoto T, Nakajima T, Matsuda T (2014) Colorectal ESD: current indications and latest technical advances. Gastrointest Endosc Clin N Am 24:245–255

    Article  Google Scholar 

  21. Takeuchi Y, Uedo N, Ishihara R et al (2010) Efficacy of an endo-knife with a water-jet function (Flushknife) for endoscopic submucosal dissection of superficial colorectal neoplasms. Am J Gastroenterol 105:314–322

    Article  Google Scholar 

  22. Toyoizumi H, Kaise M, Arakawa H et al (2009) Ultrathin endoscopy versus high-resolution endoscopy for diagnosing superficial gastric neoplasia. Gastrointest Endosc 70:240–245

    Article  Google Scholar 

  23. Maslekar S, Pillinger SH, Sharma A, Taylor A, Monson JR (2007) Cost analysis of transanal endoscopic microsurgery for rectal tumours. Colorectal Dis 9:229–234

    Article  CAS  Google Scholar 

  24. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. http://handbook-5-1.cochrane.org. Accessed 2 Dec 2018

  25. Hon SS, Ng SS, Chiu PW et al (2011) Endoscopic submucosal dissection versus local excision for early rectal neoplasms: a comparative study. Surg Endosc 25:3923–3927

    Article  Google Scholar 

  26. Hitzler MH, Heintz A (2015) Single centre study: results of transanal endoscopic microsurgery of rectal tumors since 2003 vs. results of endoscopic submucosal dissection reported in the literature. Zentralbl Chir 140:645–650

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Thomas R. McCarty, Ahmad Najdat Bazarbashi, Kelly E. Hathorn, Christopher C. Thompson & Hiroyuki Aihara

Authors
  1. Thomas R. McCarty
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmad Najdat Bazarbashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kelly E. Hathorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher C. Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroyuki Aihara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroyuki Aihara.

Ethics declarations

Disclosures

Chris C. Thompson is a consultant for Boston Scientific, Olympus America, and Apollo Endosurgery. Hiroyuki Aihara is a consultant for Olympus America, Boston Scientific, and Fujifilm Medical Systems. Thomas R. McCarty, Ahmad Najdat Bazarbashi, and Kelly E. Hathorn have no conflicts to disclose.

Ethical approval

Institutional IRB approval and written consent was not required given the design of this systematic review and meta-analysis.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McCarty, T.R., Bazarbashi, A.N., Hathorn, K.E. et al. Endoscopic submucosal dissection (ESD) versus transanal endoscopic microsurgery (TEM) for treatment of rectal tumors: a comparative systematic review and meta-analysis. Surg Endosc 34, 1688–1695 (2020). https://doi.org/10.1007/s00464-019-06945-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-06945-1

Keywords

Search

Navigation