Evidence map›Paper›PMID 38914887›Full record

ArticleSurgical endoscopy2024

Endoscopic submucosal dissection versus endoscopic mucosal resection for the treatment of rectal lesions involving the dentate line.

Konstantinos Kouladouros, Johanna Jakobs, Petros Stathopoulos, Georg Kähler, Sebastian Belle, Ulrike Denzer

Abstract readComparative StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Surgical endoscopy, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Endoscopic intermuscular dissection of a rectal gastrointestinal stromal tumor.VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy · 2026
    Article
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  5. Review
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  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Konstantinos KouladourosCentral Interdisciplinary Endoscopy Department, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. kouladou@otenet.gr.ORCID 0000-0001-8294-6673
Johanna JakobsEndoscopy Unit, Department of Gastroenterology, Endocrinology, Metabolic Diseases and Clinical Infectiology, Marburg University Hospital, Baldingerstrasse, 35043, Marburg, Germany.
Petros StathopoulosEndoscopy Unit, Department of Gastroenterology, Endocrinology, Metabolic Diseases and Clinical Infectiology, Marburg University Hospital, Baldingerstrasse, 35043, Marburg, Germany.
Georg KählerCentral Interdisciplinary Endoscopy Department, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Sebastian BelleCentral Interdisciplinary Endoscopy Department, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Ulrike DenzerEndoscopy Unit, Department of Gastroenterology, Endocrinology, Metabolic Diseases and Clinical Infectiology, Marburg University Hospital, Baldingerstrasse, 35043, Marburg, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe ideal treatment of epithelial neoplastic rectal lesions involving the dentate line is a controversial issue. Piecemeal endoscopic mucosal resection (EMR) is the most commonly used resection technique, but it is associated with high recurrence rates. Endoscopic submucosal dissection (ESD) has been shown to be safe and effective for the treatment of rectal lesions, but evidence is lacking concerning its application close to the dentate line. The aim of our study is to compare ESD and EMR for the treatment of epithelial rectal lesions involving the dentate line.

methodsWe identified all cases of endoscopic resections of rectal lesions involving the dentate line performed in two German high-volume centers between 2010 and 2022. Periinterventional and follow-up data were collected and retrospectively analyzed.

resultsWe identified 68 ESDs and 62 EMRs meeting our inclusion criteria. ESD showed a significant advantage in en bloc resection rates (89.7% vs. 9.7%; P = 0.001) and complete resection rates (72.1% vs. 9.7%; P = 0.001). The overall curative resection rate was similar between both groups (ESD: 92.6%, EMR: 83.9%; P = 0.324), whereas in the subgroup of low-risk adenocarcinomas ESD was curative in 100% of the cases vs. 14% in the EMR group (P = 0.002). There was one local recurrence after ESD (1,5%) vs. 16 (25.8%) after EMR (P < 0.0001), and the EMR patients required an average of three further interventions.

conclusionESD is superior to EMR for the treatment of epithelial rectal lesions involving the dentate line and should be considered the treatment of choice.

Indexed as

Endoscopic Mucosal ResectionRectal NeoplasmsAdenocarcinomaAgedAged, 80 and overDissectionFemaleHumansIntestinal MucosaMaleMiddle AgedRetrospective StudiesTreatment OutcomeAnorectal junctionEndoscopic resectionLaterally spreading tumorRectal adenomaRectal cancer

Identifiers

PMID38914887
PMCPMC11289217

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.