P5657 - Endoscopic Submucosal Dissection versus Trans-Anal Endoscopic Surgery for Rectal Tumors: An Updated Systematic Review and Meta-Analysis

Abdallfatah Abdallfatah, ¹, Mohamed A. Aldemerdash, ², Ahmed Farid Gadelmawla, MD³, Butros Fakhoury, MD⁴, Ahmed Bahnasy, MS⁵, Vanessa Pamela Salolin-Vargas, MD⁶, Mohamed Hamed, MD⁷, Mohammed Hassan Morsy, ⁸, Salma Allam, ⁹, Ahmed R. A. Abou-Shanab, MD¹⁰, Ahmed Salem, MD¹¹, Mohamed Eldesouki, MD¹², Mohammed Abusuliman, MD¹³, Arshia Sethi, ¹⁴, Omar Abdelhalim, MD¹⁵, Hazem Abosheaishaa, MD¹⁶
1Faculty of Medicine, October 6 University, Giza, Al Jizah, Egypt; 2Sohag University, Faculty of Medicine, Sohag, Suhaj, Egypt; 3Menoufia University, Menoufia, Al Minufiyah, Egypt; 4Virginia Commonwealth University, Richmond, VA; 5Mayo Clinic, Rochester, MN; 6Gastroenterology Consultants, Mexico City, Distrito Federal, Mexico; 7University of alexandria, Alexandria, Al Iskandariyah, Egypt; 8Faculty of medicine, Alexandria University, Alexandria, Egypt, Alexandria, Al Iskandariyah, Egypt; 9Galala University, Suez, As Suways, Egypt; 10School of health sciences Liberty University, Virginia, USA, Lynchburg, VA; 11Maimonides Medical Center, New York , USA, New York, NY; 12Saint Michael's Medical Center, New York Medical College, Newark, NJ; 13Henry Ford Hospital, Detroit , MI , USA, Detroit, MI; 14Icahn School of Medicine at Mount Sinai, New York, NY; 15Icahn School of Medicine at Mount Sinai, Queens, NY; 16Mount Sinai West, Icahn School of Medicine at Mount Sinai, Queens, NY

Introduction: Colorectal cancer, particularly rectal cancer, poses significant mortality risks globally. In our systematic review and meta-analysis, we investigate the efficacy and safety of Endoscopic submucosal dissection (ESD) versus trans-anal endoscopic microsurgery (TES) for managing early-stage rectal tumors.

Methods: Systematic literature retrieval was performed in PubMed, Web of Science, Scopus, and Embase from inception to April 2025. Risk of bias assessment was performed by using the Newcastle Ottawa Scale (NOS) for observational studies and Cochrane tool for assessing risk of bias in randomized trials (ROB2). Data-analysis was conducted using R version 4.2.2 (2022-10-31) and RStudio version 2022.07.2 (2009-2022, RStudio, Inc.)

Results: A total of 14 studies involving 1,312 patients were analyzed, revealing comparable rates of recurrence, en bloc resection, and complication rates (bleeding and perforation) between ESD and TES. Notably, ESD demonstrated a significantly higher R0 resection rate (OR: 0.51, 95% CI: 0.30–0. 88; P = 0.0160) and shorter hospital stays compared to TES (MD: -1.22, 95% CI: -2.10– -0.35; P =0.0063). Subgroup analyses indicated that tumor type influences outcomes, with TES showing superiority for neuroendocrine tumors.

Discussion: Despite the findings supporting current guidelines for both techniques, variations in surgical protocols and observational study designs raise concerns about biases and generalizability. Ultimately, the choice of technique should be tailored to individual tumor and patient characteristics, emphasizing the need for personalized treatment strategies. Future prospective randomized controlled trials are recommended to establish standardized protocols and long-term efficacy.


Figure: PRISMA flow chart showing different stages of screening and number of studies included


Figure: Forest plot showing the pooled OR for R0 resection rate, comparing ESD with TEM

Disclosures:
Abdallfatah Abdallfatah indicated no relevant financial relationships.
Mohamed A. Aldemerdash indicated no relevant financial relationships.
Ahmed Farid Gadelmawla indicated no relevant financial relationships.
Butros Fakhoury indicated no relevant financial relationships.
Ahmed Bahnasy indicated no relevant financial relationships.
Vanessa Pamela Salolin-Vargas indicated no relevant financial relationships.
Mohamed Hamed indicated no relevant financial relationships.
Mohammed Hassan Morsy indicated no relevant financial relationships.
Salma Allam indicated no relevant financial relationships.
Ahmed R. A. Abou-Shanab indicated no relevant financial relationships.
Ahmed Salem indicated no relevant financial relationships.
Mohamed Eldesouki indicated no relevant financial relationships.
Mohammed Abusuliman indicated no relevant financial relationships.
Arshia Sethi indicated no relevant financial relationships.
Omar Abdelhalim indicated no relevant financial relationships.
Hazem Abosheaishaa indicated no relevant financial relationships.

Abdallfatah Abdallfatah, ¹, Mohamed A. Aldemerdash, ², Ahmed Farid Gadelmawla, MD³, Butros Fakhoury, MD⁴, Ahmed Bahnasy, MS⁵, Vanessa Pamela Salolin-Vargas, MD⁶, Mohamed Hamed, MD⁷, Mohammed Hassan Morsy, ⁸, Salma Allam, ⁹, Ahmed R. A. Abou-Shanab, MD¹⁰, Ahmed Salem, MD¹¹, Mohamed Eldesouki, MD¹², Mohammed Abusuliman, MD¹³, Arshia Sethi, ¹⁴, Omar Abdelhalim, MD¹⁵, Hazem Abosheaishaa, MD¹⁶. P5657 - Endoscopic Submucosal Dissection versus Trans-Anal Endoscopic Surgery for Rectal Tumors: An Updated Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.