Long-Term Clinical Efficacy and Perioperative Safety of Endoscopic Submucosal Dissection versus Endoscopic Mucosal Resection for Early Gastric Cancer: An Updated Meta-Analysis.

Yajie Zhao,Chengfeng Wang

doi:10.1155/2018/3152346

Abstract

Background To systematically evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) for early gastric cancer (EGC). Methods We searched the databases of PubMed, Web of Science, EMBASE, and the Cochrane Library from January 2000 to April 2017 and included studies that compared the outcomes of ESD with EMR for EGC. These eligible studies that met the inclusion criteria were screened out and were assessed by two independent investigators. Result In total, 18 retrospective cohort studies were eligible for analysis. Our results indicated that ESD is more beneficial than EMR in increasing the complete resection rate and en bloc resection rate and decreasing the local recurrence rate. However, ESD prolonged operative time and increased incidence of gastric perforation than EMR. No differences were found in postoperative bleeding rate between the two approaches. Conclusion Compared with EMR, ESD offers higher complete resection rate, higher en bloc resection rate, and lower local recurrence rate but has prolonged operative time and increased incidence of gastric perfusion. There is no statistical difference in the rate of postoperative bleeding between the two groups. However, the above conclusion needs further verification by well-designed, randomized trials with larger samples and long follow-up periods.

Highlights

Endoscopic mucosal resection (EMR) technique is widely accepted as standard treatment for early gastric cancer (EGC)[1]
Despite the convenience of endoscopic mucosal resection (EMR), larger lesions cannot be completely removed by EMR in one attempt; the entire pathologic specimen cannot be retrieved, and a proper treatment decision cannot be made by clinicians through precise pathological examination, which leads to a potentially high risk of local tumor recurrence or excessive treatment
The analysis showed a higher rate of en bloc resection in the endoscopic submucosal dissection (ESD) group than in the EMR group

Summary

Introduction

Endoscopic mucosal resection (EMR) technique is widely accepted as standard treatment for early gastric cancer (EGC)[1]. Endoscopic mucosal resection (EMR) technique is widely accepted as standard treatment for early gastric cancer (EGC). There are few meta-analyses comparing the efficacy and safety of endoscopic submucosal dissection with endoscopic mucosal resection for EGC. To systematically evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) for early gastric cancer (EGC). We searched the databases of PubMed, Web of Science, EMBASE, and the Cochrane Library from January 2000 to April 2017 and included studies that compared the outcomes of ESD with EMR for EGC. These eligible studies that met the inclusion criteria were screened out and were assessed by two independent investigators

Methods

Findings

Discussion

Conclusion