Comparison of EMR versus endoscopic submucosal dissection for Barrett's neoplasia and esophageal adenocarcinoma: a systematic review and meta-analysis

Background and Aims: EMR and endoscopic submucosal dissection (ESD) are both accepted resection strategies for Barrett's esophagus-related neoplasia and esophageal adenocarcinoma (EAC). However, a lack of consensus exists regarding which technique offers superior outcomes. This study aims to systematically review the evidence comparing EMR versus ESD in treating Barrett's neoplasia and EAC. Methods: We searched 3 databases (Embase, MEDLINE, Cochrane Central) through October 2023. We included studies comparing the efficacy of EMR and ESD for Barrett's neoplasia and EAC. Primary outcomes include en bloc, R0, and curative resection; complete remission of dysplasia (CRD), and local recurrence. Secondary outcomes encompass adverse events. Results: Our search identified 905 records. Eleven studies were included in the final analyses. Data showed significantly higher en bloc resection rates with ESD (odds ratio [OR], 31.53; 95% confidence interval [CI], 10.02-99.19; P < .01; 7 studies). R0 resection rates were significantly higher with ESD (OR, 5.92; 95% CI, 2.75-12.77; P < .01; 8 studies). Curative resection rates tended to be higher with ESD (OR, 3.49; 95% CI, 0.86-14.14; P = .080; 4 studies). There was no significant difference in CRD rates (OR, 0.92; 95% CI, 0.37-2.26; P = .86; 3 studies). Local recurrence rates tended to be lower with ESD (OR, 0.35; 95% CI, 0.11-1.04; P = .058; 10 studies). As for adverse events, there was no significant difference in bleeding, perforation, and postoperative stricture rates. Conclusions: This systematic review and meta-analysis demonstrates that ESD achieves higher en bloc, R0, and curative resection rates, with a tendency toward lower recurrence rates. These results suggest that ESD may be a more effective option for managing Barrett's neoplasia and EAC. (International Prospective Register of Systematic Reviews [PROSPERO] registration number: CRD42023426486.)