Efficacy and safety of endoscopic submucosal dissection for lesions originating from the anal canal: a systematic review and meta-analysis

Background Anal canal lesions (ACLs) represent a significant clinical challenge requiring consideration of sphincter function preservation. Endoscopic submucosal dissection (ESD) is a promising minimally invasive technique for en bloc resection, yet its application in the anal canal is technically demanding due to the narrow lumen and somatic innervation. We conducted this meta-analysis to evaluate the efficacy and safety of ESD for ACLs. Methods Following PRISMA guidelines, we searched PubMed, Scopus, and Web of Science through February 2026. Eligible studies involved adult patients undergoing ESD for lesions originating in the anal canal. Primary outcomes were en bloc and R0 resection rates. Secondary outcomes included complications and local recurrence. Pooled proportions were calculated using random-effects models. Results Four retrospective studies involving 150 patients were included. The pooled en bloc resection rate was 94.1% (95% CI: 89.6%–97.4%). The R0 resection rate was 84.8% (95% CI: 78.7%–90.0%). Safety analysis revealed pooled incidences of anal pain at 18.7% (95% CI: 0.0%–60.0%), delayed bleeding at 6.6% (95% CI: 1.1%–16.1%), and anal stenosis at 1.1% (95% CI: 0.0%–3.7%). The pooled local recurrence rate was 4.7% (95% CI: 0.6%–12.3%). Median follow-up for the studies ranged from 9 to 37 months. Conclusion In experienced centers, ESD appears to be a feasible and promising organ-preserving approach for anal canal lesions, achieving high en bloc and R0 resection rates with low early recurrence. Comparative and longer-term data would help define its role relative to surgical excision or repeated ablative therapies.