Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal neoplastic lesions: a systematic review and meta-analysis

Wei Peng,Xiaowei Tang,Huan Li,Yutang Ren,Shali Tan,Xiangsheng Fu,Yan Peng

doi:10.1186/s13019-020-1074-9

Abstract

BackgroundPresently, endoscopic submucosal tunnel dissection (ESTD) has been a novel therapy for superficial esophageal neoplastic lesions (SENL), especially for circumferential neoplastic lesions. A number of studies have reported the clinical application of ESTD with promising outcomes. Therefore, we conducted a systematic review and meta-analysis to evaluated the efficacy and safety of ESTD for SENL .MethodsFrom 2013 to November 2018, Pubmed, Embase and Cochrane databases were searched to determine studies reporting ESTD treatment of SENL. Weighted pooled rates (WPR) were calculated for en bloc resection, R0 resection and complication of ESTD. Risk ratios (RR) were calculated and pooled to compare the clinical outcomes of ESTD with ESD for SENL.ResultsA total of 9 studies involving 494 patients with 518 esophageal neoplastic lesions were included in our study. WPR for en bloc resection and R0 resection of ESTD was 97.0% (95% CI: 94.7–98.3%) and 84.1% (95% CI: 80.5–87.1%), respectively. WPR for complication was 40.0% (95% CI: 25.8–56.1%). Two studies with 265 patients compared the performance of ESTD with ESD. Pooled RR for en bloc resection and R0 resection was 1.04 (95% CI: 0.95–1.14, P = 0.42) and 1.01 (95% CI: 0.93–1.10, P = 0.73), respectively. Pooled RR for complication was 0.68 (95% CI: 0.46–1.01, P = 0.05).ConclusionOur study showed that ESTD is effective for treating SENL with high en bloc resection rate and R0 resection rate, but accompanying by a relatively high complications.

Highlights

Endoscopic submucosal tunnel dissection (ESTD) has been a novel therapy for superficial esophageal neoplastic lesions (SENL), especially for circumferential neoplastic lesions
Search results The database search yielded a total of 112 potential articles, while no further article was identified by a manual search of the reference lists
According to the Paris classification to distinguish the macroscopic type of esophageal neoplastic lesions, 18 (3.5%) lesions were classified as type I, 139 (26.8%) as type IIa, 132 (25.5%) as type IIb, 43 (8.3%) as type IIc, 13 (2.5%) as type IIa + IIb, 54 (10.4%) as type IIa + IIc, 1 (0.2%) as type IIb + IIc, and 3 (0.6%) as type III

Summary

Introduction

Endoscopic submucosal tunnel dissection (ESTD) has been a novel therapy for superficial esophageal neoplastic lesions (SENL), especially for circumferential neoplastic lesions. A number of studies have reported the clinical application of ESTD with promising outcomes. We conducted a systematic review and meta-analysis to evaluated the efficacy and safety of ESTD for SENL. Peng et al Journal of Cardiothoracic Surgery (2020) 15:33 technique for the treatment of esophageal neoplastic lesions, especially circumferential superficial esophageal neoplastic lesions (SENLs) [10]. A number of singlecenter studies have reported promising outcomes with the clinical application of ESTD [11, 12]. The primary aim of this systematic review and meta-analysis was to investigate the efficacy and safety of ESTD for SENLs in terms of the R0 resection rate, the en bloc resection rate, complications, and other parameters. The clinical outcomes between ESTD and ESD for the treatment of SENLs were compared

Methods

Results

Discussion

Conclusion