Abstract
Objective. To explore and define the current optimal submucosal injection solution used in ESD and EMR for gastrointestinal tract neoplasms in terms of clinical outcomes and other aspects. Methods. PubMed, Cochrane Library, Embase, and clinical trials register center were searched with terms of “endoscopic resection” and “submucosal injection solution” to identify relevant randomized controlled trials (RCTs). Both direct comparison using traditional meta-analysis method and indirect comparison using network meta-analysis method were performed. Results. A total of 11 RCTs with 1152 patients were included. Meta-analysis showed that, compared with normal saline, other submucosal injection solutions induced a significant increase in terms of en bloc resection rate (I 2 = 0%, OR = 2.11, 95% CI (1.36, 3.26), and P = 0.008) and complete resection rate (I 2 = 0%, OR = 2.14, 95% CI (1.41, 3.24), and P = 0.0003); and there was no significant difference in the incidence of total complications (I 2 = 0%, OR = 0.87, 95% CI (0.59, 1.29), and P = 0.49). Conclusions. Other newly developed submucosal injection solutions significantly increased en bloc resection rate and complete resection rate and decreased bleeding rate and finical cost of endoscopic resection in gastrointestinal tract, while current evidence did not find the difference between them, which need to be explored by further studies.
Highlights
With the diagnosis technique and accuracy of early gastrointestinal (GI) tract cancer increased, endoscopic treatment is widely applied as a radical curative therapy [1]
The methodological method assessment showed that 7 randomized controlled trials (RCTs) reached a level of A [10,11,12, 15, 16, 19, 20], 2 RCTs reached a level of B [13, 17], and 2 RCTs reached a level of C [14, 18] (Table 2)
Though there was no significant difference in the incidence of total complications (I2 = 0%, OR = 0.87, 95% CI (0.59, 1.29), and P = 0.49, Figure 5)
Summary
With the diagnosis technique and accuracy of early gastrointestinal (GI) tract cancer increased, endoscopic treatment is widely applied as a radical curative therapy [1]. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are the most frequently used as they are minimally invasive especially for sessile and flat polyps [2]. They are proposed as replacements for invasive surgery in early gastrointestinal neoplasm (with low risk of lymph-node metastasis) due to simplified procedure, decreased cost, improved quality of life, and favorable long-term benefit [3, 4]. Many studies have compared the various injections in EMR and ESD for GI tract neoplasm in terms of clinical efficacy and safety
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