Short-term outcomes of endoscopic submucosal dissection for the treatment of superficial gastric neoplasms in non-Asian countries: a systematic review and meta-analysis

Abstract

Background Endoscopic submucosal dissection (ESD) is now considered the standard treatment for early gastric cancer (EGC). However, the widespread adoption of ESD in western countries has been slow. We performed a systematic review to evaluate short-term outcomes of ESD for EGC in non-Asian countries. Methods We searched 3 electronic databases from inception until October 26, 2022. Primary outcomes were en bloc , R0 and curative resections rate by region. Secondary outcomes were overall complications, bleeding, and perforation rate by region. The proportion of each outcome, with the 95% confidence interval (CI), was pooled using a random-effects model with the Freeman-Tukey double arcsine transformation. Results Twenty-seven studies from Europe (n=14), South America (n=11) and North America (n=2) were included, involving 1875 gastric lesions. Overall, en bloc , R0, and curative resection rates were achieved in 96% (95%CI 94-98%), 85% (95%CI 81-89%), and 77% (95%CI 73-81%) of cases, respectively. Considering only information from lesions with adenocarcinoma, the overall curative resection was 75% (95CI 70-80%). Bleeding and perforation were observed in 5% (95%CI 4-7%) and 2% (95%CI 1-4%) of cases, respectively. Conclusion Our results suggest that short-term outcomes of ESD for the treatment of EGC are acceptable in non-Asian countries.

Comparison of vonoprazan and proton pump inhibitors for the treatment of gastric endoscopic submucosal dissection-induced ulcer: an updated systematic review and meta-analysis

“…Delayed postoperative bleeding is the most common complication induced by ESD. Benites-Goñi et al reported that delayed postoperative bleeding occurred in 5-7% of patients who underwent ESD [35]. Of the nine RCTs included in our meta-analysis, the rate of delayed postoperative bleeding in the vonoprazan group ranged from 0 to 5.4%.…”

Value of quantitative microsurface structure analysis for evaluating the invasion depth of type 0–II early gastric cancer

“…found that patients with well‐differentiated lesions sized <3 cm, lesions showing a submucosal invasion depth of <500 μm, and undifferentiated lesions sized <2 cm confined to the mucosa were almost entirely free of lymph node metastasis. Such lesions were included in the absolute indications or expanded indications for endoscopic resection 2–5 . The invasion depth of early gastric cancer is currently determined using traditional and ultrasound endoscopy 6–8 .…”

“…Such lesions were included in the absolute indications or expanded indications for endoscopic resection. 2 , 3 , 4 , 5 The invasion depth of early gastric cancer is currently determined using traditional and ultrasound endoscopy. 6 , 7 , 8 The results of traditional and ultrasound endoscopy did not meet the needs of endoscopic submucosal dissection.…”

Endoscopic submucosal dissection for gastric lesions

“…We read with great interest the recently published systematic review by Benites-Goñi et al on the short-term outcomes of endoscopic submucosal dissection for the treatment of superficial gastric neoplasms in non-Asian countries [ 1 ]. Regrettably, we noted that our previous study published in 2020, indexed in PubMed with full open access, was not included in the analysis.…”

“…Therefore, the estimates reported in this systematic review could have been different if the data from our study had also been considered. We would suggest that the authors should carry out a further check of the accuracy in the literature review they performed on October 26, 2022 [ 1 ].…”