Modified endoscopic mucosal resection versus endoscopic submucosal dissection for rectal neuroendocrine tumors ≤10 mm: a systematic review and meta-analysis of randomized controlled trials
In brief
Modified EMR achieves same complete resection rate as ESD for up to 10 mm rectal NETs
A meta-analysis of six randomized trials (440 patients) found that modified endoscopic mucosal resection is no less effective than endoscopic submucosal dissection in achieving histologic complete resection of small rectal neuroendocrine tumors, while taking less time and costing less. The evidence is of moderate certainty, supporting m-EMR as a reasonable first-line option.
- Journal
- Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Q1)
- Published
- 3 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Ke Pang, Lujing Ying, Hemiao Xu, Yabing Wang, Wangyang Chen, Daiyu Yang, et al.
- PMID
- 42547360
- DOI
- 10.1016/j.dld.2026.07.012
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 9 August 2026): RCT meta‑analysis of m‑EMR vs ESD for small rectal NETs
- Picked for Hepatology (top studies of the week, 9 August 2026).
- Picked for Histology (top studies of the week, 9 August 2026).
Abstract
BACKGROUND: Endoscopic resection is the standard treatment for rectal neuroendocrine tumors (r-NETs) ≤10 mm, yet the optimal technique remains debated. Modified endoscopic mucosal resection (m-EMR) has been proposed as an alternative to endoscopic submucosal dissection (ESD), but prior evidence is mainly retrospective and recent randomized controlled trials (RCTs) are inconclusive. METHODS: We systematically searched CENTRAL, PubMed, Embase, and WanFang from January 1, 1970 to December 23, 2025, for RCTs comparing m-EMR and ESD in r-NETs ≤10 mm. Evidence certainty was evaluated using GRADE, and trial sequential analysis (TSA) was conducted to support the statistical stability of the pooled estimate. RESULTS: Six RCTs involving 440 patients were included. No significant differences were found between m-EMR and ESD in histologic complete resection (RR = 1.00, 95% CI 0.97-1.03; I² = 0%), en bloc resection (P = 0.75), or procedure-related adverse events (P = 0.94). m-EMR was associated with significantly shorter procedure time and lower hospitalization cost. Evidence certainty was moderate; TSA confirmed the reliability of the findings, and both cumulative and sensitivity analyses supported the robustness. CONCLUSION: m-EMR provides comparable short-term histologic efficacy to ESD, while being associated with shorter procedure time and lower hospitalization costs, supporting its consideration as a reasonable first-line option for r-NETs ≤10 mm.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.