Table 45.2 summarizes the literature. The table is organized to reflect those factors for which TEM/TES (collectively referred to as TES) has advantages to, is equal to, or is disadvantageous compared to the alternative techniques. Overall there is a paucity of manuscripts comparing these techniques with the other methods of local excision. As stated above, a randomized prospective study is not likely to appear because once the technique is mastered, some form of TES will become the preferred approach for surgeons. There is only one prospective, randomized study and excision of only adenomas is considered. [2] Of the remaining studies, there are 3 meta-analyses, [3–5] one systematic review, [6] and several retrospective series [7–14] where the control groups are within the same institution, other institutions, or literature based. Study designs are generally flawed.