Endoscopy 2009; 41(9): 751-757
DOI: 10.1055/s-0029-1215053
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract

Y.  Cao1 , C.  Liao1 , A.  Tan1 , Y.  Gao2 , Z.  Mo2 , F.  Gao1
  • 1Department of Colorectal and Anal Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
  • 2Department of Urology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
Weitere Informationen

Publikationsverlauf

submitted 3 March 2009

accepted after revision 7 July 2009

Publikationsdatum:
19. August 2009 (online)

Preview

Background and study aims: Endoscopic submucosal dissection (ESD) has been developed to overcome the limitations of endoscopic mucosal resection (EMR). We aimed to compare the outcomes of these two methods.

Methods: Databases, including Pubmed, EMBASE, and The Cochrane Library, were searched to identify studies comparing ESD with EMR for premalignant and malignant lesions of the gastrointestinal tract. In a meta-analysis, primary end points were the en bloc resection rate and the curative resection rate; secondary end points were operation time, and rates of bleeding, perforation, and local recurrence.

Results: 15 nonrandomized studies (seven full-text and eight abstracts) were identified. Meta-analysis showed higher en bloc and curative resection rates (odds ratio [OR] 13.87, 95 %CI 10.12 – 18.99; OR 3.53, 95 %CI 2.57 – 4.84) irrespective of lesion size. Subgroup analysis showed higher en bloc and curative resection rates with ESD for esophageal, gastric, and colorectal neoplasms, and for lesions of size < 10 mm, 10 mm < 20 mm, and > 20 mm. Local recurrence was lower with ESD (OR 0.09, 95 %CI 0.04 – 0.18). But ESD was more time-consuming than EMR (weighted mean difference [WMD] 1.76; 95 %CI 0.60 – 2.92), and showed high procedure-related bleeding and perforation rates (OR 2.20, 95 %CI 1.58 – 3.07; OR 4.09, 95 %CI 2.47 – 6.80).

Conclusions: ESD showed better en bloc and curative resection rates and local recurrence compared with EMR, but was more time-consuming and had higher rates of bleeding and perforation complications. These results need to be confirmed by high quality trials and further studies in the west.

References

Feng GaoPhD 

Department of Colorectal and Anal Surgery
First Affiliated Hospital, Guangxi Medical University

Nanning, Guangxi
People’s Republic of China

Fax: +86-771-5356529

eMail: doctorgao0771@hotmail.com