Endoscopic submucosal dissection vs. endoscopic mucosal resection for early gastric cancer: a meta-analysis

BACKGROUND: This study aimed to evaluate the efficacy and safety of endoscopic mucosal resection (EMR) versus endoscopic submucosal dissection (ESD) in the treatment of early gastric cancer (EGC) through a meta-analysis, and to provide evidence-based guidance for clinical decision-making. METHODS: Relevant studies were systematically retrieved from PubMed, EMBASE, Web of Science, the Cochrane Library, and major Chinese databases. Randomized controlled trials (RCTs) comparing EMR and ESD for EGC were included. Meta-analysis was performed using Review Manager 5.3 software. The primary outcomes included en bloc resection rate, curative resection rate, local tumor recurrence, procedure time, and complications. Subgroup analyses were performed according to procedure time, follow-up duration, and lesion type to explore potential sources of heterogeneity. RESULTS: A total of nine studies comprising 3,574 patients were included. The results showed that ESD was associated with significantly higher en bloc resection and curative resection rates compared to EMR (OR = 4.00, p < 0.00001; OR = 1.95, p < 0.00001, respectively), and a significantly lower postoperative recurrence rate (OR = 1.97, p < 0.00001). However, ESD required longer procedure time and involved higher technical complexity, demanding advanced endoscopic skills. Subgroup analyses revealed that the advantages of ESD were more pronounced in patients with differentiated-type lesions (OR = 3.85, p < 0.001), procedures longer than 120 min (OR = 3.45, p < 0.001), and in settings with follow-up durations exceeding 3 years (OR = 4.20, p < 0.001). CONCLUSION: ESD provides superior therapeutic efficacy over EMR in early gastric cancer, particularly in differentiated lesions and long-term follow-up settings, though it demands greater technical expertise and longer operative time. These findings support ESD as the preferred approach for appropriately selected EGC patients.