Endoscopic submucosal dissection of gastric neoplastic lesions in Western countries: systematic review and meta-analysis

Abstract

Endoscopic submucosal dissection (ESD) for gastric neoplastic lesions removal is largely performed in Asian countries. Unfortunately, ESD diffusion, particularly for gastric lesion removal, is still limited in Western countries. We performed a systematic review of available data coming from Western centers. The en bloc and the R0 resection rates for all neoplastic lesions, including early gastric cancer (EGC) and dysplasia, were calculated, as well as the curative rate for EGC. Complications and the 1-month mortality rates were computed. A total of 22 studies from Europe (N = 15), Latina America (N = 6), and Canada (N = 1) were retrieved, with 1152 patients and 1210 lesions. The en bloc resection was successful in 96% [95% confidence interval (CI) 93–98] with a significant heterogeneity (I 2 = 63.5%; P < 0.0001). The R0 was achieved in 84% (95% CI 79–89; I 2 = 79.9%; P < 0.001). The resection rate was curative in 72% out of 340 patients with EGC (95% CI 65–79, I 2 = 8%; P = 0.36). Overall, complications occurred in 9.5% of patients, including bleeding (5.8%), perforation (3.4%), and stenosis (0.35%). A total of three (0.26%) patients deceased within 1 month, but none was directly related to the procedure. Lesion recurrence was observed in 38 (3.5%; 95% CI 2.3–4.4) cases, including 21 EGC and 17 dysplasia. In Western countries, the en bloc and the R0 resections were successful in the large majority of cases, whilst the resection was curative in 72% of patients with EGC. The complications rate was acceptably low.

Efficacy and Safety of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasms: A Latin American Cohort Study

“…Our perforation rate was slightly higher than that reported by Oda in a review of 28 Japanese and Korean studies, including > 300 gastric ESD each, which ranged from 1.2%-5.2%, and also higher than the values reported by Zullo et al in a meta-analysis of Western studies with an overall rate of 3.4% (95% confidence interval [CI], 2.5%-4.6%). 27,30 However, as Zullo et al 27 pointed out, the perforation rate was higher in studies with few patients, even reaching 22%. The perforation rate is closely related to the learning curve.…”

“…[22][23][24][25][26] A systematic review including six Latin American studies, revealed en bloc, R0, and curative overall resection rates of 96%, 84%, and 72%, respectively. 27 To our knowledge, the largest Western series of ESD for EGC has recently been published by Ngamruengphong et al, 28 who reported en bloc, R0, and curative resection rates of 92.2%, 91.8%, and 58.7%, from 347 lesions resected in several hospitals in the United States. An important Latin American study by Arantes et al 13 reported achieving en bloc and R0 resection rates of > 90% and a curative resection rate of 76% in 35 adenomas and 42 EGCs resected by ESD.…”

“…A meta-analysis of Western studies revealed an overall delayed bleeding rate of 5.8% (95% CI, 4.6%-7.3%). 27 The strength of this study is that it has one of the largest cohorts of patients with EGC and premalignant gastric lesions treated by ESD in non-Eastern countries with the largest proportion in Latin America. The limitations of this study are the relatively small number of patients compared to those in Eastern studies, its retrospective design, and unavailable shortterm data.…”

“…In our study, we achieved high en bloc , R0, and curative resection rates at 98.0%, 96.1%, and 89.5%, respectively, which are similar to those in Japanese and Korean studies (92%–99.4%, 90.1%–97.3%, and 73.6%–94.7%, respectively) [ 22 – 26 ]. A systematic review including six Latin American studies, revealed en bloc , R0, and curative overall resection rates of 96%, 84%, and 72%, respectively [ 27 ]. To our knowledge, the largest Western series of ESD for EGC has recently been published by Ngamruengphong et al [ 28 ], who reported en bloc , R0, and curative resection rates of 92.2%, 91.8%, and 58.7%, from 347 lesions resected in several hospitals in the United States.…”

A narrative review of postoperative bleeding in patients with gastric cancer treated with endoscopic submucosal dissection

“…The rate of post-ESD bleeding is also various (0-15.6%) (12)(13)(14)(15); this rate for patients with antithrombotic agents or anticoagulants is even higher. Takeuchi et al (16) found that post-ESD bleeding in antithrombotic group was 23.3%, significantly higher than 2.0% in the non-antithrombotic group.…”