Published online Jun 21, 2018. doi: 10.3748/wjg.v24.i23.2518
Peer-review started: March 11, 2018
First decision: March 29, 2018
Revised: May 5, 2018
Accepted: June 2, 2018
Article in press: June 2, 2018
Published online: June 21, 2018
To compare endoscopic submucosal dissection (ESD) outcomes between Eastern and Western countries.
A systematic review and meta-analysis was performed using PubMed, MEDLINE, Web of Science, CINAHL and EBM reviews to identify studies published between 1990 and February 2016. The primary outcome was the efficacy of ESD based on information about either curative resection, en bloc or R0 resection rates. Secondary outcomes were complication rates, local recurrence rates and procedure times.
Overall, 238 publications including 84318 patients and 89512 gastrointestinal lesions resected using ESD were identified. 90% of the identified studies reporting ESD on 87296 lesions were conducted in Eastern countries and 10% of the identified studies reporting ESD outcomes in 2216 lesions were from Western countries. Meta-analyses showed higher pooled percentage of curative, en bloc, and R0 resection in the Eastern studies; 82% (CI: 81%-84%), 95% (CI: 94%-96%) and 89% (CI: 88%-91%) compared to Western studies; 71% (CI: 61%-81%), 85% (CI: 81%-89%) and 74% (CI: 67%-81%) respectively. The percentage of perforation requiring surgery was significantly greater in the Western countries (0.53%; CI: 0.10-1.16) compared to Eastern countries (0.01%; CI: 0%-0.05%). ESD procedure times were longer in Western countries (110 min vs 77 min).
Eastern countries show better ESD outcomes compared to Western countries. Availability of local ESD expertise and regional outcomes should be considered for decision making to treat gastrointestinal lesions with ESD.
Core tip: Endoscopic submucosal dissection (ESD) has become the preferred approach to remove larger or advanced gastrointestinal lesions in Asian countries. However, there might be regional differences in outcomes since the majority of ESD publications come from the Eastern world. To provide such information we conducted a systematic review and meta-analysis comparing ESD outcomes for different regions of the world. This study found that there are indeed regional differences for ESD outcomes. Eastern countries had better curative, en bloc and R0 resection rate than Western countries as well as less perforation requiring surgery.