The efficacy and safety of endoscopic submucosal resection in periappendiceal lesions: a systematic review and meta-analysis

Introduction Endoscopic submucosal dissection (ESD) is a promising technique for early-stage gastrointestinal neoplasms; however, its use for periappendiceal lesions poses challenges because of anatomical complexities and the potential risk of appendicitis or perforation. As a result, these lesions are often managed surgically. This systematic review and meta-analysis evaluate the safety and efficacy of ESD for periappendiceal lesions. Methodology A systematic search across multiple databases was conducted, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies focused on adult populations undergoing ESD for periappendiceal lesions. The primary outcome was a technical success, and secondary outcomes included R0 resection, en-bloc resection, adverse events, and need for surgery. Data were reported using percentages with associated confidence intervals (CIs) and heterogeneity ( I ²). Results Six studies comprising 298 patients were included. Technical success was achieved in 98% (95% CI: 97–100%, I 2 : 4.63%), with R0 resection and en-bloc resection rates of 84% (95% CI: 77–91%, I 2 : 61.86%) and 92% (95% CI: 86–97%, I 2 : 66.11%), respectively. The overall rates of polyp recurrence, appendicitis, and bleeding were 0.1% (95% CI: 0–2%, I 2 : 0%), 3% (95% CI: 0–4%, I 2 : 0%), and 1% (95% CI: 0–3%, I 2 : 0%), respectively. Conversely, perforation exhibited a relatively high incidence of 11% (95% CI: 3–19%, I 2 : 84.55%); however, the need for surgical intervention was 6% (95% CI: 1–10%, I 2 : 74.12%). Conclusion ESD provides a safe and effective alternative to surgical resection for managing periappendiceal lesions.