Daoud DC, Suter N, Durand M, Bouin M, Faulques B, von Renteln D. Comparing outcomes for endoscopic submucosal dissection between Eastern and Western countries: A systematic review and meta-analysis. World J Gastroenterol 2018; 24(23): 2518-2536 [PMID: 29930473 DOI: 10.3748/wjg.v24.i23.2518]
Corresponding Author of This Article
Madeleine Durand, FRCP(C), MD, MSc, Assistant Professor, Doctor, Department of Medicine, Division of Internal Medicine, Centre hospitalier de l’Université de Montréal (CHUM) and Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), 850 Rue Saint-Denis, Montréal, Québec H2X 0A9, Canada. madeleine.durand@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jun 21, 2018; 24(23): 2518-2536 Published online Jun 21, 2018. doi: 10.3748/wjg.v24.i23.2518
Comparing outcomes for endoscopic submucosal dissection between Eastern and Western countries: A systematic review and meta-analysis
Dane Christina Daoud, Nicolas Suter, Madeleine Durand, Mickael Bouin, Bernard Faulques, Daniel von Renteln
Dane Christina Daoud, Mickael Bouin, Bernard Faulques, Daniel von Renteln, Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l’Université de Montréal (CHUM) and Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
Nicolas Suter, Madeleine Durand, Department of Medicine, Division of Internal Medicine, Centre Hospitalier de l’Université de Montréal (CHUM) and Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
Author contributions: Daoud DC designed the study, collected and analyzed the data and wrote the manuscript; Suter N collected and analyzed the data; Durand M performed the statistical analysis and analyzed the data; von Renteln D designed the study, analyzed the data and wrote the manuscript; Bouin M and Faulques B revised the manuscript critically for intellectual content; and all the authors provided intellectual input for the study and approved the final version of the manuscript.
Conflict-of-interest statement: None of the authors have any potential personal conflict of interest with regard to the study to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Madeleine Durand, FRCP(C), MD, MSc, Assistant Professor, Doctor, Department of Medicine, Division of Internal Medicine, Centre hospitalier de l’Université de Montréal (CHUM) and Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), 850 Rue Saint-Denis, Montréal, Québec H2X 0A9, Canada. madeleine.durand@gmail.com
Telephone: +1-514-8908444
Received: March 10, 2018 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
Abstract
AIM
To compare endoscopic submucosal dissection (ESD) outcomes between Eastern and Western countries.
METHODS
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.
RESULTS
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).
CONCLUSION
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.
