Yonsei Med J.  2015 Jan;56(1):72-81. 10.3349/ymj.2015.56.1.72.

Efficacy and Safety of Endoscopic Resection Therapies for Rectal Carcinoid Tumors: A Meta-Analysis

• He L
• Deng T
• Luo H

• KMID: 2352791
• DOI: http://doi.org/10.3349/ymj.2015.56.1.72

Abstract

PURPOSE
Several endoscopic resection therapies have been applied for the treatment of rectal carcinoid tumors. However, there is currently no consensus regarding the optimal strategy. We performed a meta-analysis to compare the efficacy and safety of endoscopic mucosal resection (EMR) or modified EMR (m-EMR) versus endoscopic submucosal dissection (ESD) for the treatment of rectal carcinoid tumors.
MATERIALS AND METHODS
PubMed, Web of Science, Medline, Embase and CNKI were searched up to the end of January 2014 in order to identify all studies on the effects of EMR (or m-EMR) and ESD on rectal carcinoid tumors.
RESULTS
A total of fourteen studies involving 782 patients were included. The pooled data suggested a significantly higher rate of pathological complete resection among patients treated with ESD or m-EMR than those treated with EMR [odds ratio (OR)=0.42, 95% confidence interval (CI): 0.25-0.71; OR=0.10, 95% CI: 0.03-0.33, respectively], while there was no significant difference between the m-EMR group and ESD group (OR=1.19, 95% CI: 0.49-2.86); The procedure time of ESD was longer than EMR or m-EMR groups [mean differences (MD)=-11.29, 95% CI: -14.19 - -8.38, MD= -10.90, 95% CI: -18.69 - -3.11, respectively], but it was insignificance between the EMR and m-EMR groups. No significant differences were detected among the treatment groups with regard to complications or recurrence.
CONCLUSION
The results of this meta-analysis suggest that treatment of rectal carcinoid tumors with ESD or m-EMR is superior to EMR, and the efficacy of m-EMR is equivalence to ESD treatment. However, more well-designed studies are needed to confirm these findings.

Keyword

Endoscopic submucosal dissection; endoscopic mucosal resection; rectal carcinoid tumor; meta-analysis

MeSH Terms

Carcinoid Tumor/pathology/*surgery
Dissection/adverse effects
Endoscopy, Gastrointestinal/*adverse effects
Humans
Intestinal Mucosa/pathology/surgery
Intestinal Neoplasms/pathology/*surgery
Middle Aged
Neoplasm Recurrence, Local/pathology
Postoperative Complications/etiology
Publication Bias
Rectal Neoplasms/pathology/*surgery
Time Factors
Treatment Outcome
Tumor Burden

Figure

• 

  Fig. 1 Forest plots comparing treatment of rectal carcinoid tumors with ESD or EMR (or m-EMR) in terms of pathologically complete resection rate. (A) ESD vs. EMR. (B) ESD vs. m-EMR. (C) EMR vs. m-EMR. ESD, endoscopic submucosal dissection; EMR, endoscopic mucosal resection; m-EMR, modified EMR; CI, confidence interval.

• 

  Fig. 2 Forest plots comparing treatment of rectal carcinoid tumors with ESD or EMR (or m-EMR) in terms of the procedure time. (A) ESD vs. EMR. (B) ESD vs. m-EMR. (C) EMR vs. m-EMR. ESD, endoscopic submucosal dissection; EMR, endoscopic mucosal resection; m-EMR, modified EMR; CI, confidence interval.

• 

  Fig. 3 Forest plots comparing treatment of rectal carcinoid tumors with ESD or EMR in terms of the complications or recurrence. (A) Bleeding. (B) Perforations. (C) Recurrence. ESD, endoscopic submucosal dissection; EMR, endoscopic mucosal resection; CI, confidence interval.

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