COMPARISON OF TUNNEL AND CLASSICAL METHODS OF ENDOSCOPIC SUBMUCOSAL DISSECTION IN EPITHELIAL COLON TUMORS (systematic review and meta-analysis)

Abstract

BACKGROUND: endoscopic submucosal dissection (ESD) is a modern effective method for patients with benign epithelial tumors and early colorectal cancer.The use of such a technique for ESD as a submucosal tunnel (‘pocket’) – creation under a tumor creates conditions for improving the surgical specimen qualityand reducingfragmentationrate.Aim: to study the effectiveness and safety of the tunnel method of ESD (TESD) in comparison with classical ESD (CESD) in colorectal adenomas and early colorectal cancer.MATERIALS AND METHODS: literature search and meta-analysis were performed in accordance with the PRISMA recommendations using the PUBMED search system in the Medline electronic database without limiting publication datesin the English language literature. The systematic review included all the studies on comparison of the tunnel and classical ESD methods.RESULTS: the analysis included 4 studies (1,422 patients, 458 in the TESD group and 961 in the CESD group). The groups were comparable in the number of adenomas (OR=1.25; 95% CI=0.87-1.79; p=0.22), adenocarcinomas (OR=0.96; 95% CI=0.49-1.87; p=0.90), in the size of neoplasms (95% CI=-6.26-1.22; p=0.19), and in the presence of submucosal fibrosis (p=0.69). There were no significant differences in intraoperative bleeding rate (OR=1.24; 95% CI=0.53-2.88; p=0.61); however, perforations occurred more often when using CESD (OR= 0.35; 95% CI=0.15-0.83; p=0.02). The CESD took significantly longer time than the TESD (OR=-19.1; 95% CI=33.89-4.45; p=0.01). The frequency of en bloc resections (OR=16.06; 95% CI=4.95-52.11; p<0.0001) and R0-resections (OR=3.28; 95% CI=1.30-8.32; p=0.01) were significantly higher in the TESD. CONCLUSION: the tunnel method of endoscopic submucosal dissection is an effective and safe alternative to the classical method. However, there is currently a lack of data for the choice of submucosal dissection method for large colorectal adenomas and early colorectal cancer, which requires further comparative studies.