Abstract
BackgroundIn recent years, some traction-assisted approaches have been introduced to facilitate endoscopic submucosal dissection (ESD) procedures by reducing the procedure time and risks related to the procedure. However, the relative advantages of traction-assisted endoscopic submucosal dissection (T-ESD) are still being debated. This study aimed to assess the efficacy of T-ESD for the treatment of superficial gastrointestinal neoplasms.MethodsWe searched MEDLINE, Embase, and Cochrane library up to March 31, 2019 for randomized controlled trials (RCTs) comparing T-ESD and conventional endoscopic submucosal dissection (C-ESD) for superficial gastrointestinal neoplasms. The main endpoints are en bloc resection, complete resection, procedure time, perforation, and delayed bleeding. Pooled risk ratio (RR), Peto odds ratio (OR), and mean difference (MD) were calculated to compare T-ESD and C-ESD. This study is registered with PROSPERO, number CRD42018108135.ResultsA total of 7 RCTs with 1007 patients were included in this meta-analysis. There were no significant differences between the T-ESD and C-ESD groups in the pooled estimate of en bloc resection, complete resection, and delayed bleeding (RR = 1.00, 95% CI 0.99, 1.01, I2 = 0%, P = 0.66; RR = 1.00, 95% CI 0.98, 1.03, I2 = 0%, P = 0.81; OR = 0.95, 95% CI 0.48, 1.86, I2 = 19%, P = 0.87,respectively). The pooled estimate indicated that the procedure time was significantly shorter in the T-ESD group (MD = − 16.19, 95% CI − 29.24, − 3.13, I2 = 87%, P = 0.02) than in the C-ESD group. Compared to C-ESD, T-ESD was associated with lower incidence of perforation (OR = 0.32, 95% CI 0.11, 0.91, I2 = 0%, P = 0.03).ConclusionsT-ESD is a safe and effective treatment option with a low perforation rate and shorter procedure time than C-ESD for superficial gastrointestinal neoplasms. Future multi-center (including European populations), randomized controlled trials of larger sample size and long-term outcomes of T-ESD are required.
Highlights
Superficial gastrointestinal (GI) neoplasms are defined as lesions limited to the mucosa or submucosa without invading the muscularis propria, regardless of the presence of lymph node involvement
There are several treatment options for GI neoplasms, such as the endoscopic mucosal resection (EMR) [5], endoscopic submucosal dissection (ESD) [6], and surgical resection of the tumor and regional lymph nodes through laparoscopic or open operation [7]
Eligibility criteria We included randomized controlled trials (RCTs) that included a comparison of traction-assisted endoscopic submucosal dissection (T-ESD) vs conventional endoscopic submucosal dissection (C-ESD) for patients with superficial gastrointestinal neoplasms and that explicitly reported data on at least one of the outcomes: en bloc resection, complete resection, procedure time, perforation, or delayed bleeding
Summary
Superficial gastrointestinal (GI) neoplasms are defined as lesions limited to the mucosa or submucosa without invading the muscularis propria, regardless of the presence of lymph node involvement. The endoscopic treatment of EMR was initially introduced for gastric neoplasms, and subsequently, for esophageal neoplasms and colorectal neoplasms. It has been widely accepted as the standard treatment for superficial gastrointestinal neoplasms because of its minimal invasiveness. It is difficult to complete the en bloc resection, and this difficulty results in low curative resection and high local recurrence. To overcome this problem, ESD was developed for superficial gastrointestinal neoplasms, and it has been rapidly adopted all over the world. This study aimed to assess the efficacy of T-ESD for the treatment of superficial gastrointestinal neoplasms
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