Endoscopic submucosal dissection versus endoscopic mucosal resection for the treatment of rectal tumors extending to the dentate line: a systematic review and meta-analysis.

[PURPOSE] We performed a systematic review and meta-analysis to compare the efficacy and safety of endoscopic submucosal dissection (ESD) with those of endoscopic mucosal resection (EMR) for rectal tumors extending to the dentate line (RTDLs).

[METHODS] We searched the PubMed, Embase, Web of Science and the Cochrane Library databases up to July 2025 for studies that reported the clinical outcomes of EMR or ESD for RTDLs.

[RESULTS] Fifteen studies (237 for EMR and 564 for ESD) were included in this meta-analysis. The en bloc resection rate (0.961 vs. 0.097; p = 0.000) was significantly greater in the ESD group than in the EMR group, and the local recurrence rate (0.023 vs. 0.188; p = 0.000) was significantly lower in the ESD group. No significant differences in the complete resection rate (0.793 vs. 0.823, p = 0.869) were noted between the ESD and EMR groups. In terms of adverse events, there were no differences in the postoperative bleeding rate (0.067 vs. 0.082; p = 0.677), perforation rate (0 vs.0; p = 0.605) or stricture rate (0.022 vs. 0.042; p = 0.378) between the ESD and EMR groups.

[CONCLUSION] ESD and EMR are effective and safe treatments for RTDLs; however, compared with EMR, ESD is associated with a higher en bloc resection rate and a lower local recurrence rate.