Efficacy and safety of endoscopic submucosal tunnel dissection vs endoscopic submucosal dissection for early superficial upper gastrointestinal precancerous lesions and tumors: A meta‐analysis

Abstract

Objective Endoscopic submucosal tunnel dissection (ESTD) is a new treatment for superficial upper gastrointestinal precancerous lesions and tumors. However, its safety and efficacy for treating these lesions is still uncertain. This meta‐analysis aimed to compare the efficacy and safety of ESTD with those of endoscopic submucosal dissection (ESD) in treating early superficial upper gastrointestinal precancerous lesions and tumors. Methods Electronic databases, including EMBASE, PubMed, Cochrane Library and the Web of Science, were systematically searched for articles published up to 1 April 2020. The primary outcomes were complete and en bloc resection rates of the lesions. The secondary outcomes included operation time, speed of dissection, complication and recurrence rates. The Newcastle‐Ottawa quality assessment scale was used to evaluate the quality of the studies. Results Seven studies were included in the final meta‐analysis. The complete and en bloc resection rates of early superficial esophageal lesions as well as the en bloc resection rate of early superficial gastric lesions were similar between the ESTD and ESD groups. Compared with the ESD group, the ESTD group had a higher en bloc resection rate for early superficial gastric lesions. A faster dissection speed was observed in both superficial esophageal and gastric lesions. In gastric lesions, the operation time of the ESTD group was shorter than that of the ESD group, while it did not differ for esophageal lesions. There were no obvious differences in bleeding and perforation rates between the groups. Conclusion As an endoscopic technique for treating early superficial upper gastrointestinal lesions, ESTD is as safe as and more effective than ESD, especially for gastric lesions.

Risk Factors for Fever After Esophageal Endoscopic Submucosal Dissection and Its Derived Technique

“…Intraoperative perforation was defined as a visible hole in the esophageal wall, exposing the mediastinal space during the endoscopic procedure ( 19 ). En-bloc resection was defined as whole resection of the tumor into a non-fragmenting piece ( 20 , 21 ). Lesion size was the maximum diameter measured by postoperative pathological specimens.…”

“…Twelve (2.7%) lesions were located in the upper 1/3 of the esophagus, 348 (78.0%) lesions were located in the middle 1/3 of esophagus and 86 (19.3%) lesions were located in the lower 1/3 of the esophagus. Median (range) lesion size was 15 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) mm. Most lesion were leiomyomas (49.7%), 20.4% (91/446) of lesions were squamous cell carcinomas and 59 (13.2) lesions were dysplasia.…”

Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasia in close proximity to esophageal varices: a multicenter international experience

“…The study included a total of 23 patients [16 This article is protected by copyright. All rights reserved.…”

“…The risk of bleeding and perforation in esophageal ESD for SEN, in the absence of cirrhosis is 0.7-2.6% and 1.7%-5.4%, respectively [16][17][18][19]. The cirrhotic population is thought to be at a higher risk of adverse events in the setting of coagulopathy, thrombocytopenia and the varices itself.…”

Deep Learning-Based Ultrasound Combined with Gastroscope for the Diagnosis and Nursing of Upper Gastrointestinal Submucous Lesions

“…Upper gastrointestinal submucous lesions usually refer to the protrusion lesions covered by a normal mucous membrane in the upper gastrointestinal tract, manifesting as smooth and continuous spherical or semispherical swelling under a gastroscope, mainly including stromal tumor, leiomyoma, cyst, lipoma, and hemangioma [ 1 , 2 ]. The lesion lacks specificity.…”