Efficacy, Safety and Long-Term Outcomes of Endoscopic Submucosal Dissection for Inflammatory Bowel Disease-Associated Colorectal Neoplasia: A Systematic Review and Meta-Analysis Comparing Asian and Western Outcomes

Abstract

Background and aims: Endoscopic submucosal dissection (ESD) is increasingly being adopted worldwide for the treatment of colorectal neoplastic lesions. However, its role in patients with inflammatory bowel disease (IBD) remains debatable, particularly due to increased risk of submucosal fibrosis from chronic inflammation, which can theoretically impact the clinical outcomes of this technique. This study aimed to assess the efficacy and safety of ESD for colorectal neoplastic lesions in IBD patients, comparing Asian and Western settings.

Methods: A systematic review was conducted by searching MEDLINE and Web of Science until January 2025. We included primary studies reporting ESD performance in IBD patients. We performed random-effects meta-analysis for several outcomes, including en-bloc, R0, and curative resection rates, frequency of adverse events (post-procedural bleeding and perforation), local recurrence and need for additional surgery after ESD. Certainty of evidence was assessed using GRADE.

Results: We included 20 studies (565 patients and 732 lesions). The meta-analytical frequencies of en-bloc, R0, and curative resection rates were 95.7% (95%CI=93.5-97.9%; I²=60.1%), 84.6% (95%CI=79.4-90.1%; I²=68.9%), and 83.9% (95%CI=76.3-92.4%; I²=75.9%), respectively. Bleeding and perforation occurred in 7.0% (95%CI=4.4-11.2%; I²=16.9%) and 7.9% (95%CI=5.3-11.9%; I²=2.4%) of cases, respectively. Local recurrence frequency was 5.3% (95%CI=3.5-7.9%; I²=0%). The meta-analytical need for additional surgery was 13.3% (95%CI=9.5-18.1%; I²=42.5%). No differences were found between Asian and Western studies for any outcome. The certainty of evidence was considered "low" in 4 outcomes and "very low" in the remaining outcomes.

Conclusion: ESD appears effective and safe for treating colorectal neoplastic lesions in IBD patients. Similar results were observed between Asian and Western studies.