S0939 Efficacy and Safety of Pocket Creation Endoscopic Submucosal Dissection for the Resection of Gastrointestinal Lesions: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: Endoscopic submucosal dissection (ESD) is an accepted method for the resection of lesions in the gastrointestinal tract. A newer adaptation of this technique is the pocket-creation method ESD (PC-ESD) which involves the utilization of a small caliber tip transparent hood to create a pocket beneath the lesion with minimal mucosal incision. The purpose of this study was to perform a systematic review and meta-analysis to assess the efficacy and safety of PC-ESD for the resection of gastrointestinal lesions. METHODS: We conducted a comprehensive search of several databases from inception to May 2020. The primary outcome assessed was the pooled technical success rate of PC-ESD. Secondary outcomes included pooled rates of en-block resection, R0 resection, and adverse events. A meta-regression was performed by tumor size. A comparison of the above outcomes was performed for PC-ESD vs. SP-ESD and also based on tumor location. RESULTS: A total of 20 studies were included for analysis. There were 960 patients with 973 lesions resected. The mean tumor size was 30.5 mm. The locations of the lesions were as follows: 880 colorectum (17 studies), 52 stomach (2 studies), 13 esophagus (2 studies), and 28 small bowel (1 study). Five of the studies utilized SP-ESD technique and the remaining 15 studies used standard PC-ESD. The overall pooled rate of technical success was 97% (94.6–98.4). The pooled rate of en-bloc removal was 96.6% (91.9–98.6) and R0 resection rate was 91.2% (88.9–93.1). The pooled rate of adverse events was 5.5% (4.1–7.4) with the majority being self-limited bleeding. A meta-regression analysis was performed based on tumor size and there was no difference found. In comparing SP-ESD and PC-ESD, the R0 resection rate was higher for SP-ESD (96.6% vs. 90.6%, P = 0.04). There was no difference for en-bloc removal or adverse events. In comparing the colorectum with other locations, the rate of technical success was higher in the colorectum (98% vs. 89%, P = 0.05). There were no differences in R0 resection rates or adverse events between locations. The study results are summarized in Tables 1 and 2. CONCLUSION: Based on this systematic review and meta-analysis, PC-ESD has high pooled rates of technical success, en-block removal, and R0 resection. Based on these results, PC-ESD is a safe and effective technique for the resection of gastrointestinal lesions.Table 1.: Pooled Results of PC-ESD and SP-ESDTable 2.: Comparison by Location