Meta-Analysis of Tip-in Versus Conventional EMR for Colorectal Lesions

Meta-Analysis of Tip-in Versus Conventional EMR for Colorectal Lesions

Douglas K. Rex, MD, MASGE, reviewing Niu C, et al. J Clin Gastroenterol 2023 Jun 28.

Tip-in endoscopic mucosal resection (T-EMR) involves submucosal injection, followed by a small incision into the submucosal mound on the cecal side of the lesion. The snare tip is anchored in the opening into the submucosa, and the anchored snare is opened over the lesion.

This systematic review and meta-analysis compared T-EMR and conventional EMR (C-EMR). Eleven studies, 3 of which were randomized controlled trials, met the inclusion criteria. The odds ratios for en bloc resection and complete resection comparing T-EMR with C-EMR were 3.61 and 2.49, respectively. Procedure time and complication rates were similar with the two techniques.

Douglas K. Rex, MD, FASGE


The 11 studies included 6 from South Korea, 3 from Japan, one from Taiwan, and one from France. The results suggest more consideration of Tip-in EMR in the U.S. and other Western countries is warranted.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Niu C, et al. Tip-in versus conventional endoscopic mucosal resection for colorectal neoplasia a systematic review and meta-analysis. J Clin Gastroenterol 2023 Jun 28. (Epub ahead of print) (

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