Abstract
AimFor patients with superficial esophageal carcinoma, ESD was one of treatment modalities to remove the lesion safely and effectively. We perform this meta-analysis to determine the efficacy and incidence of complication of ESD for patients with superficial esophageal carcinoma.MethodArticles were searched in MEDLINE (PubMed and Ovid), Cochrane Database of Systemic Reviews, Google scholar, and Web of Science. Two reviewers independently searched and extracted data. Meta-analysis of the efficacy of ESD was analyzed by calculating pooled en bloc and R0 resection rate. Incidence of complications such as perforation, stenosis and mediastinal emphysema was also calculated. Pooling was conducted using either fixed-effects model or random-effects model depending on the heterogeneity across studies.Results21 studies (1152 patients and 1240 lesions) were included in this analysis. The pooled en bloc resection rate was 99% (95% CI 99%-100%). Stratified by tumor size, en bloc resection rates did not show any significant difference. The pooled R0 resection rate was 90% (95% CI 87%-93%). The pooled R0 resection rate was 85% (95% CI, 80%-90%) for large tumor and 92% (95% CI, 87%-93%) for small tumor (p < 0.001). Stenosis served as the most common reported complication with pooled incidence of 5% (95% CI 3-8%), followed by perforation (1%, 95% CI 0-1%) and mediastinal emphysema (0% CI 0-1%). The incidence of postoperative stenosis decreased significantly after 2011 (2%, 95% CI 0-3%) compared with that before 2011 (9%, 95% CI 3-8%) (p < 0.001).ConclusionESD was an efficient modality for treating superficial esophageal carcinoma, with perfect en bloc and R0 resection rate and low complication rate. The most common complication of ESD was stenosis. Although recurrence rate was low, patients should be maintained in a scheduled surveillance program.
Highlights
An increasing number of esophageal carcinoma is diagnosed worldwide each year [1]
The pooled en bloc resection rate was 99%
Stenosis served as the most common reported complication with pooled incidence of 5%, followed by perforation (1%, 95% Confidential interval (CI) 0-1%) and mediastinal emphysema
Summary
An increasing number of esophageal carcinoma is diagnosed worldwide each year [1]. Endoscopic treatment of early esophageal carcinoma has been increasingly conducted around the world, which aims to maintain the integrity of the esophagus and avoid the considerable morbidity and mortality of esophagectomy. A number of studies were conducted to assess the efficacy and durability of ESD. The results of these studies were rather controversial with the R0 resection rate ranging from 71% to 97% [6,7]. ESD has been recently recognized as one of the standard treatments for superficial esophageal carcinoma (SEC) in Japan [8], it is highly technique demanding because the wall of the esophagus is thinner than that of stomach and the narrow lumen of the esophagus restricts endoscopic manipulation. Life-threatening complications such as perforation and mediastinal emphysema occur with the incidence of 4-10% [8,9,10]
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