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Endoscopic submucosal dissection of gastric tumors: A systematic review and meta-analysis

World Journal of Gastrointestinal Endoscopy 2016年第15期8卷 517-532页

作者： Emmanuel Akintoye Itegbemie Obaitan arunkumar muthusamy Olalekan Akanbi Mayowa Olusunmade Diane Levine Department of Internal Medicine Wayne State University School of Medicine/Detroit Medical Center Department of Emergency Medicine Brigham and Women’s Hospital Department of Internal Medicine Presence Saint Joseph Hospital School of Public Health Harvard University

AIM: To systematically review the medical literature in order to evaluate the safety and efficacy of gastric endoscopic submucosal dissection(ESD).METHODS: We performed a comprehensive literature search of MEDLINE, Ovid, CINAHL, and Cochrane for studies reporting on the clinical efficacy and safety profile of gastric ***: Twenty-nine thousand five hundred and six tumors in 27155 patients(31% female) who underwent gastric ESD between 1999 and 2014 were included in this study. R0 resection rate was 90%(95%CI: 87%-92%) with significant between-study heterogeneity(P < 0.001) which was partly explained by difference in region(P = 0.02) and sample size(P = 0.04). Endoscopic en bloc and curative resection rates were 94%(95%CI: 93%-96%) and 86%(95%CI: 83%-89%) respectively. The rate of immediate and delayed perforation rates were 2.7%(95%CI: 2.1%-3.3%) and 0.39%(95%CI: 0.06%-2.4%) respectively while rates of immediate and delayed major bleeding were 2.9%(95%CI: 1.3-6.6) and 3.6%(95%CI: 3.1%-4.3%). After an average follow-up of about 30 mo post-operative, the rate of tumor recurrence was 0.02%(95%CI: 0.001-1.4) among those with R0 resection and 7.7%(95%CI: 3.6%-16%) among those without R0 resection. Overall, irrespective of the resection status, recurrence rate was 0.75%(95%CI: 0.42%-1.3%).CONCLUSION: Our meta-analysis, the largest and most comprehensive assessment of gastric ESD till date, showed that gastric ESD is safe and effective for gastrictumors and warrants consideration as first line therapy when an expert operator is available.

关键词： Endoscopic submucosal dissection Gastric neoplasms Meta-analysis

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