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
Endoscopic submucosal dissection (ESD) has become the preferred approach to remove advanced gastrointestinal lesions in Asian countries while widespread adoption in the Western world remains limited.
Many previous meta-analyses suggest that ESD is a superior technique for treatment of precancerous gastrointestinal lesions or early cancers. However, there might be regional differences in outcomes since the majority of ESD publications come from the Eastern world. Studies evaluating differences for ESD outcomes between Eastern and Western countries are lacking.
To provide a global comparison of ESD outcomes between Eastern and Western countries.
A systematic review and meta-analysis were conducted on studies reporting ESD outcomes. Were excluded studies with less than 50 patients, using hybrid ESD technique or targeting subepithelial lesions. Primary and secondary outcomes were efficacy of ESD (curative, en bloc and R0 resection), complications (bleeding, perforation) and other related factors as local recurrence and procedural time.
Our meta-analysis showed that Eastern countries have better ESD outcomes compared to Western countries for curative, en bloc and R0 resection. ESD performed in Western countries were associated with a higher proportion of perforation requiring surgery. Subgroups analysis by organ showed similar outcomes for gastric lesions while Eastern countries had better curative, en bloc and R0 resection rates for colorectal lesions.
This meta-analysis provided evidence that there are regional differences for ESD outcomes. Eastern countries show better ESD outcomes compared to Western countries.
Clinical decision-making for or against ESD should consider such outcomes and locally available expertise. Standardized reporting of outcomes should be used for future ESD studies.