Comparison of endoscopic mucosal resection combined with band ligation versus endoscopic submucosal dissection for small rectal neuroendocrine tumors (≤ 10 mm): a systematic review and meta-analysis

Abstract Background To systematically evaluate the efficacy and safety of endoscopic mucosal resection with ligation (EMR-L) vs. endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors (rNETs) ≤ 10 mm. Methods Databases including PubMed, Embase, Web of Science, Cochrane Library, CNKI and Wanfang Data were searched from establishment to October 30, 2025, to collect studies comparing EMR-L and ESD for rNETs. Two researchers independently screened literature, extracted data and assessed quality; meta-analysis was performed via RevMan 5.4 and R software. Results Eighteen studies involving 1,185 patients were included. Meta-analysis revealed that the EMR-L group had significantly shorter operative time (MD = -18.67; 95% CI: -25.06 to -12.28, p < 0.001) compared to the ESD group. No significant intergroup differences were noted in R0 resection (RR = 1, 95%CI:0.95–1.06, p = 0.88), en bloc resection (RR = 1.00, 95%CI:0.99–1.02, p = 0.89), horizontal/vertical margin positivity (p = 0.33/p = 0.89), postoperative bleeding (p = 0.69) or perforation (p = 0.62). Notably, EMR-L group was associated with significantly shorter hospital stays (MD = -2.41; 95% CI: -3.7 to -1.06, p < 0.001) and lower hospitalization costs (MD = -3212.1; 95% CI: -5625.9 to -798.3, p = 0.009) compared to ESD group. Conclusion In summary, for rNETs ≤ 10 mm, EMR-L seems to have comparable efficacy and safety compared to ESD, and it also appears to have advantages such as shorter operation time, shorter hospital stays, and lower cost, although there is some heterogeneity.