Gastric endoscopic submucosal dissection: a systematic review and meta-analysis on risk factors for poor short-term outcomes

Abstract

Objective Endoscopic submucosal dissection (ESD) is now established as the first option to manage early gastric neoplasms, but its efficacy may vary according to diverse factors. We aimed to systematically identify risk factors for poor short-term outcomes of gastric ESD with the purpose to improve patients’ selection and management. Methods Three online databases (MEDLINE, ISI Web of Knowledge and Scopus) were searched (last search on June 2018) for poor outcomes of gastric ESD (deep submucosal invasion, piecemeal/incomplete resection, noncurative resection and local recurrence). Results One hundred five studies were included referring to 52.126 ESDs. Undifferentiated histology and upper location (vs lower) were associated with submucosal invasion [odds ratio (OR) = 2.42 [95% confidence interval (CI), 1.62–3.61] and OR = 3.20 (1.04–9.86), respectively] and deep submucosal invasion [OR = 2.98 (2.02–4.39) and OR = 2.35 (1.45–3.81), respectively]. Lesion size greater than 30 mm and ulceration were associated with piecemeal resection [OR = 2.78 (1.17–6.60) and OR = 2.76 (1.23, 6.20), respectively]. Lesion size greater than 30 mm, ulceration, upper location and fibrosis were risk factors for incomplete resection [OR = 3.83 (2.68–5.49), OR = 4.06 (1.62–10.16), OR = 3.71 (2.49–5.54) and OR = 4.46 (1.66–11.96), respectively]. A noncurative resection was more often observed for lesions located in the upper third of the stomach [OR = 1.49 (1.24–1.79)], depressed morphology [OR = 1.49 (1.04–2.12)] and those outside standard criteria [OR = 3.56 (2.31–5.48)]. Older age was significantly linked with local recurrence rates [OR = 3.08 (1.13–5.02)]. Conclusion Several risk factors influence poor efficacy short-term outcomes of gastric ESD that may be used to inform both patients and health providers about the expected efficacy.

Risk factors for gastric metachronous lesions after endoscopic or surgical resection: a systematic review and meta-analysis

“…Characteristics of the index lesion were not significantly associated with MGL. It is clear that these morphological features influence the probability of curative resection [29] but after curative resection is achieved, the characteristics of the index lesion do not seem to affect the occurrence of MGL. Conversely, the presence of synchronous lesions was associated with neoplasm recurrence.…”

Metachronous lesions after gastric endoscopic submucosal dissection: first assessment of the FAMISH prediction score

“…However, despite curative ER, there is a persistent risk of developing metachronous gastric lesions (MGL) after ESD [2] with a reported cumulative incidence ranging from 5.2% to 22.7% at 10-years of follow-up [8,14]. Because ESD is a minimally invasive and gastric mucosa sparing technique, this incidence is significantly higher than for gastrectomy (0.9-3.0%) [4,[14][15][16].…”

“…However, despite curative endoscopic resection, there is a persistent risk of developing metachronous gastric lesions (MGL) after ESD [2], with a reported cumulative incidence ranging from 5.2 % to 22.7 % at 10 years of follow-up [8,14]. As ESD is a minimally invasive and gastric mucosa-sparing technique, the MGL incidence after ESD is significantly higher than that for gastrectomy (0.9 %-3.0 %) [4,[14][15][16]. Previous studies showed that up to 96 % of MGLs were amenable to endoscopic resection [10,14,[17][18][19][20] or, less frequently, to surgical resection [10,14,[17][18][19][20].…”

The future of endoscopic resection for early gastric cancer

“…On the other hand, lesion characteristics such as size greater than 30 mm (OR = 2.78) and ulceration were associated with piecemeal resection. Finally, a noncurative resection was more often observed for lesions located in the upper third of the stomach (OR = 1.49 [1.24–1.79]), depressed morphology (OR = 1.49 [1.04–2.12]), and those outside standard criteria (OR = 3.56 [2.31–5.48]) 61 …”