Tunneled or Pocket Creation Method versus Conventional Endoscopic Submucosal Dissection for Gastric Lesions – A Systematic Review and Meta-analysis

Abstract

Tunneled endoscopic submucosal dissection (T-ESD) and pocket creation method ESD (PCM-ESD) are considered to have technical advantages over conventional ESD (C-ESD). However, data comparing these techniques for ESD of gastric lesions is limited. PubMed and Cochrane databases were reviewed for relevant studies from their inception to October 31, 2023. Studies comparing T-ESD or PCM-ESD (T/PCM-ESD) to C-ESD for gastric lesions were included. The primary outcomes were dissection speed and en bloc resection. Secondary outcomes were R0 resection, recurrence, perforation, and post-ESD bleeding. A random effects meta-analysis was conducted. Eight observational studies (359 patients - T/PCM-ESD, 670 patients - C-ESD) were included. T/PCM-ESD was associated with a significantly faster dissection speed (Mean Difference: 4.42 mm2/min, 95% CI: 2.05, 6.79, I2 = 79%). There were no significant differences between the groups in terms of en bloc resection (risk ratio (RR): 1.01, 95% confidence interval (CI): 1.00-1.03, I2 = 0%), R0 resection (RR: 1.03, 95% CI: 0.99-1.07, I2 = 0%) and recurrence (RR: 0.73, 95% CI: 0.14-3.84, I2 = 0%). While T/PCM-ESD was associated with a significantly lower risk of perforation (RR: 0.21, 95% CI: 0.06-0.80, I2 = 0%), post-ESD bleeding rates were not significantly different. T/PCM-ESD facilitates faster and safer gastric ESD than conventional ESD with comparable en bloc resection, R0 resection, and recurrence rates. A future randomized controlled control trial is required.