Endoscopic submucosal dissection versus endoscopic mucosal resection for colorectal laterally spreading tumors (> 20 mm): a systematic review and meta-analysis

BACKGROUND: Colorectal laterally spreading tumors (LSTs) larger than 20 mm are significant precursors to colorectal cancer. Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are widely used treatments, but their comparative efficacy and safety remain controversial. This systematic review and meta-analysis aimed to compare ESD and EMR in terms of local recurrence, perforation, and delayed bleeding for colorectal LSTs > 20 mm. METHODS: Following PRISMA guidelines, a comprehensive literature search was conducted in PubMed, Embase, and Cochrane databases from inception to 1 May 2025. Studies comparing ESD and EMR for LSTs > 20 mm were included. Data were extracted and quality assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. Random-effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: < 5%). CONCLUSIONS: ESD significantly reduces recurrence risk for colorectal LSTs > 20 mm compared with EMR but carries a higher perforation risk. Bleeding rates are comparable between the two techniques. ESD is recommended in expert centers where technical proficiency can mitigate perforation risk, while EMR-treated patients require closer surveillance due to higher recurrence. Future studies should focus on optimizing techniques and clarifying strategies for different LST subtypes and locations.