Meta-Analysis
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 10, 2016; 8(15): 517-532
Published online Aug 10, 2016. doi: 10.4253/wjge.v8.i15.517
Endoscopic submucosal dissection of gastric tumors: A systematic review and meta-analysis
Emmanuel Akintoye, Itegbemie Obaitan, Arunkumar Muthusamy, Olalekan Akanbi, Mayowa Olusunmade, Diane Levine
Emmanuel Akintoye, Arunkumar Muthusamy, Diane Levine, Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI 48201, United States
Itegbemie Obaitan, Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
Olalekan Akanbi, Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL 60657, United States
Mayowa Olusunmade, School of Public Health, Harvard University, Boston, MA 02115, United States
Author contributions: All authors contributed to this paper.
Conflict-of-interest statement: The authors have no conflict of interest.
Data sharing statement: Dataset and statistical code available from the first author at eakintoy@med.wayne.edu.
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: Diane Levine, MD, Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, 4201 St. Antoine St, Detroit, MI 48201, United States. dllevine@med.wayne.edu
Telephone: +1-313-7457003
Received: March 26, 2016
Peer-review started: March 27, 2016
First decision: May 13, 2016
Revised: June 23, 2016
Accepted: July 11, 2016
Article in press: July 13, 2016
Published online: August 10, 2016
Processing time: 131 Days and 16.8 Hours
Abstract

AIM: To systematically review the medical literature in order to evaluate the safety and efficacy of gastric endoscopic submucosal dissection (ESD).

METHODS: We performed a comprehensive literature search of MEDLINE, Ovid, CINAHL, and Cochrane for studies reporting on the clinical efficacy and safety profile of gastric ESD.

RESULTS: Twenty-nine thousand five hundred and six tumors in 27155 patients (31% female) who underwent gastric ESD between 1999 and 2014 were included in this study. R0 resection rate was 90% (95%CI: 87%-92%) with significant between-study heterogeneity (P < 0.001) which was partly explained by difference in region (P = 0.02) and sample size (P = 0.04). Endoscopic en bloc and curative resection rates were 94% (95%CI: 93%-96%) and 86% (95%CI: 83%-89%) respectively. The rate of immediate and delayed perforation rates were 2.7% (95%CI: 2.1%-3.3%) and 0.39% (95%CI: 0.06%-2.4%) respectively while rates of immediate and delayed major bleeding were 2.9% (95%CI: 1.3-6.6) and 3.6% (95%CI: 3.1%-4.3%). After an average follow-up of about 30 mo post-operative, the rate of tumor recurrence was 0.02% (95%CI: 0.001-1.4) among those with R0 resection and 7.7% (95%CI: 3.6%-16%) among those without R0 resection. Overall, irrespective of the resection status, recurrence rate was 0.75% (95%CI: 0.42%-1.3%).

CONCLUSION: Our meta-analysis, the largest and most comprehensive assessment of gastric ESD till date, showed that gastric ESD is safe and effective for gastric tumors and warrants consideration as first line therapy when an expert operator is available.

Keywords: Endoscopic submucosal dissection; Gastric neoplasms; Meta-analysis

Core tip: Our meta-analysis, the largest and most comprehensive assessment of gastric endoscopic submucosal dissection (ESD) to date, showed that gastric ESD is safe and effective for gastric tumors when an expert operator is available. The most compelling evidence is from Asian countries and we recommend the consideration of the procedure as first line therapy in Western countries.