Published online Nov 16, 2014. doi: 10.4253/wjge.v6.i11.555
Revised: June 30, 2014
Accepted: October 1, 2014
Published online: November 16, 2014
AIM: To compare endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early gastric cancer (EGC).
METHODS: Computerized bibliographic search was performed on PubMed/Medline, Embase, Google Scholar and Cochrane library databases. Quality of each included study was assessed according to current Cochrane guidelines. Primary endpoints were en bloc resection rate and histologically complete resection rate. Secondary endpoints were length of procedure, post-treatment bleeding, post-procedural perforation and recurrence rate. Comparisons between the two treatment groups across all the included studies were performed by using Mantel-Haenszel test for fixed-effects models (in case of low heterogeneity) or DerSimonian and Laird test for random-effects models (in case of high heterogeneity).
RESULTS: Ten retrospective studies (8 full text and 2 abstracts) were included in the meta-analysis. Overall data on 4328 lesions, 1916 in the ESD and 2412 in the EMR group were pooled and analyzed. The mean operation time was longer for ESD than for EMR (standardized mean difference 1.73, 95%CI: 0.52-2.95, P = 0.005) and the “en bloc” and histological complete resection rates were significantly higher in the ESD group [OR = 9.69 (95%CI: 7.74-12.13), P < 0.001 and OR = 5.66, (95%CI: 2.92-10.96), P < 0.001, respectively]. As a consequence of its greater radicality, ESD provided lower recurrence rate [OR = 0.09, (95%CI: 0.05-0.17), P < 0.001]. Among complications, perforation rate was significantly higher after ESD [OR = 4.67, (95%CI, 2.77-7.87), P < 0.001] whereas the bleeding incidences did not differ between the two techniques [OR = 1.49 (0.6-3.71), P = 0.39].
CONCLUSION: In the endoscopic therapy of EGC, ESD showed a superior efficacy but higher complication rate with respect to EMR.
Core tip: Endoscopic submucosal dissection (ESD) represents a promising approach to the therapy of Early Gastric Cancer. Preliminar studies showed better outcomes in terms of complete en bloc and histologic resection rate with respect to classical Endoscopic Mucosal Resection (EMR). Some concerns raise due to higher complication rate (particularly perforation) and longer operation times related to the complexity of the procedure. The current meta-analysis outline the superiority of ESD in obtaining higher radical resection rate and lower recurrence rates compared to EMR but confirms the aforementioned concerns on higher incidences of perforation and bleeding (in this case non significantly) after ESD.