Efficacy and safety of endoscopic submucosal dissection for colorectal dysplasia in patients with inflammatory bowel disease: a systematic review and meta-analysis

Background/Aims: In this meta -analysis, we studied the safety and efficacy of endoscopic submucosal dissection (ESD) for colorectal dysplasia in patients with inflammatory bowel disease (IBD). Methods: Multiple databases were searched, and studies were retrieved based on pre -specified criteria until October 2022. The outcomes assessed were resection rates, procedural complications, local recurrence, metachronous tumors, and the need for surgery after ESD in IBD. Standard meta -analysis methods were followed using the random -effects model, and I 2 % was used to assess heterogeneity. Results: Twelve studies comprising 291 dysplastic lesions in 274 patients were included with a median follow-up of 25 months. The pooled en -bloc resection, R0 resection, and curative resection rates were 92.5% (95% confidence interval [CI], 87.9%-95.4%; I 2 =0%), 81.5% (95% CI, 72.5%-88%; I 2 =43%), and 48.9% (95% CI, 32.1%-65.9%; I 2 =87%), respectively. The local recurrence rate was 3.9% (95% CI, 2%-7.5%; I 2 =0%). The pooled rates of bleeding and perforation were 7.7% (95% CI, 4.5%-13%; I 2 =10%) and 5.3% (95% CI, 3.1%- 8.9%; I 2 =0%), respectively. The rates of metachronous recurrence and additional surgery following ESD were 10% (95% CI, 5.2%- 18.2%; I 2 =55%) and 13% (95% CI, 8.5%-19.3%; I 2 =54%), respectively. Conclusions: ESD is safe and effective for the resection of dysplastic lesions in IBD with an excellent pooled rate of en -bloc and R0 resection.