Safety and efficacy of endoscopic submucosal dissection vs endoscopic mucosal resection in managing gastrointestinal tract tumors: a systematic review and meta-analysis.

Background: Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are minimally invasive alternatives to surgery for gastrointestinal tumors, differing in technique, indications, and outcomes. This meta-analysis compared the efficacy and safety of ESD vs EMR. Methods: Following PRISMA guidelines, PubMed, Cochrane, Google Scholar, and Scopus were searched. Binary outcomes were pooled as odds ratios (ORs) and continuous outcomes as standardized mean differences (SMDs), with 95% confidence intervals (CIs), using a random-effects model. Analyses were performed in R (v4.4.1), with significance set at P < 0.05. Results: Twenty-five studies with 5283 patients (2234 ESD, 3049 EMR) were included. ESD achieved higher complete resection (OR, 5.77; 95% CI, 2.18-15.26; P < 0.001; I 2 = 91%) and en bloc resection rates (OR, 13.46; 95% CI, 5.91-30.64; P < 0.001; I 2 = 82%). It required longer procedural time (SMD, 1.73; 95% CI, 1.26-2.19; P < 0.01) but had lower piecemeal resection (OR, 0.06; 95% CI, 0.01-0.38; P = 0.003). Postendoscopic resection coagulation syndrome (PECS) was more frequent with ESD (OR, 2.40; 95% CI, 1.25-4.61; P = 0.008). No significant differences were found in delayed bleeding (P = 0.06) or recurrence (P = 0.61). Conclusions: ESD provides superior complete and en bloc resection compared with EMR but involves longer procedures and higher PECS risk. Large-scale trials are needed to refine comparative outcomes.