Comparing outcomes for endoscopic submucosal dissection between Eastern and Western countries: A systematic review and meta-analysis

Abstract

AIMTo compare endoscopic submucosal dissection (ESD) outcomes between Eastern and Western countries.METHODSA systematic review and meta-analysis was performed using PubMed, MEDLINE, Web of Science, CINAHL and EBM reviews to identify studies published between 1990 and February 2016. The primary outcome was the efficacy of ESD based on information about either curative resection, en bloc or R0 resection rates. Secondary outcomes were complication rates, local recurrence rates and procedure times.RESULTSOverall, 238 publications including 84318 patients and 89512 gastrointestinal lesions resected using ESD were identified. 90% of the identified studies reporting ESD on 87296 lesions were conducted in Eastern countries and 10% of the identified studies reporting ESD outcomes in 2216 lesions were from Western countries. Meta-analyses showed higher pooled percentage of curative, en bloc, and R0 resection in the Eastern studies; 82% (CI: 81%-84%), 95% (CI: 94%-96%) and 89% (CI: 88%-91%) compared to Western studies; 71% (CI: 61%-81%), 85% (CI: 81%-89%) and 74% (CI: 67%-81%) respectively. The percentage of perforation requiring surgery was significantly greater in the Western countries (0.53%; CI: 0.10-1.16) compared to Eastern countries (0.01%; CI: 0%-0.05%). ESD procedure times were longer in Western countries (110 min vs 77 min).CONCLUSIONEastern countries show better ESD outcomes compared to Western countries. Availability of local ESD expertise and regional outcomes should be considered for decision making to treat gastrointestinal lesions with ESD.

Bleeding after endoscopic submucosal dissection of gastric lesions

“…ESD originated from Japan, and in recent years it has gradually been adopted in other Asian countries as well as in the West . Compared with traditional endoscopic mucosal resection, ESD has a higher overall resection and cure rates of gastrointestinal neoplastic lesions, which can reduce the local recurrence rates . Nevertheless, due to its higher technical requirements and long operation time, various complications may occur during and after gastric ESD, among which hemorrhage is the most serious.…”

“…3,4 Compared with traditional endoscopic mucosal resection, ESD has a higher overall resection and cure rates of gastrointestinal neoplastic lesions, which can reduce the local recurrence rates. 5,6 Nevertheless, due to its higher technical requirements and long operation time, various complications may occur during and after gastric ESD, among which hemorrhage is the most serious. Severe hemorrhage after ESD can cause hemorrhagic shock and even death.…”

A Single-Center Early Experience of Endoscopic Submucosal Dissection for Gastric Lesions in Thailand

“…Although ESD is a novel, challenging technique, it carries the risks of serious complications, long procedural duration requiring substantial training, and expertise development. ESD is still gradually expanding worldwide over recent years to improve the quality of treatment modality for gastric lesions [6,[12][13][14][15][16][17][18][19][20]. In this retrospective report, the patients underwent an ESD procedure for gastric lesions, and their characteristics, postoperative courses, the results of the histopathological examination, and outcomes were analyzed.…”

“…Despite these interesting advantages, ESD was also considered a high risk at the starting point with skillful endoscopic techniques and terrible complications such as perforation and bleeding [10,11]. However, ESD remains challenging, and it has become widespread reaching insti-tutes in many parts of the world by hands-on workshops with ex vivo and in vivo animal training models under the supervision of ESD masters [12][13][14][15][16][17][18][19][20]. The current study is aimed at further investigating the feasibility, efficacy, and safety of ESD of gastric lesions and at evaluating clinical outcomes with respect to the learning curve of early experience.…”

Management of antithrombotic agents and current issues in patients undergoing endoscopic submucosal dissection

“…Endoscopic submucosal dissection (ESD) is a minimally invasive technique, that is widely used for the management of early gastrointestinal tumors, especially in Asia. [1][2][3] It has the advantage of providing higher en bloc and complete resection rates compared to endoscopic mucosal resection (EMR). 4 However, postoperative bleeding, which can be life-threatening, is a concern following ESD.…”