Long-Term Clinical Efficacy and Perioperative Safety of Endoscopic Submucosal Dissection versus Endoscopic Mucosal Resection for Early Gastric Cancer: An Updated Meta-Analysis

Abstract

Background To systematically evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) for early gastric cancer (EGC). Methods We searched the databases of PubMed, Web of Science, EMBASE, and the Cochrane Library from January 2000 to April 2017 and included studies that compared the outcomes of ESD with EMR for EGC. These eligible studies that met the inclusion criteria were screened out and were assessed by two independent investigators. Result In total, 18 retrospective cohort studies were eligible for analysis. Our results indicated that ESD is more beneficial than EMR in increasing the complete resection rate and en bloc resection rate and decreasing the local recurrence rate. However, ESD prolonged operative time and increased incidence of gastric perforation than EMR. No differences were found in postoperative bleeding rate between the two approaches. Conclusion Compared with EMR, ESD offers higher complete resection rate, higher en bloc resection rate, and lower local recurrence rate but has prolonged operative time and increased incidence of gastric perfusion. There is no statistical difference in the rate of postoperative bleeding between the two groups. However, the above conclusion needs further verification by well-designed, randomized trials with larger samples and long follow-up periods.

Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition)

“…However, meta-analyses found that, in general, better en bloc resection rates are achieved with ESD than with EMR. [52][53][54][55] It has been reported that for tumor sizes >1 cm in long diameter, en bloc resection rates are significantly lower for EMR than for ESD. [56][57][58] Physicians should refer to the Gastroenterological Endoscopy Handbook (revised 2nd edition) 4 compiled by the JGES and other relevant JGES guidelines for accurate information concerning perioperative management for ESD and EMR procedures.…”

Reduction in the procedure time of hybrid endoscopic submucosal dissection for early gastric neoplasms: a multi-center retrospective propensity score-matched analysis

“…However, the problem is that ESD for EGN is technically more difficult and time-consuming, with higher rates of adverse events, including perforation and bleeding, than EMR. 6 , 12 , 13 …”

“…However, the problem is that ESD for EGN is technically more difficult and time-consuming, with higher rates of adverse events, including perforation and bleeding, than EMR. 6,12,13 Hybrid ESD (H-ESD) is the procedure of circumferential incision with partial submucosal dissection combined with subsequent mucosal resection by snaring. H-ESD is, thus, an intermediate technique between conventional ESD (C-ESD) and EMR, which can combine the merits both of ESD and EMR.…”

Endoscopic submucosal dissection versus endoscopic mucosal resection for patients with early gastric cancer: a meta-analysis

“…The study conducted by Facciorusso et al based on 10 retrospective studies and found ESD shows superior effectiveness but higher complication risk as compared with EMR for EGC 47. The recently updated study enrolled 18 retrospective studies and found the increased incidences of complete resection, en bloc resection, and reduced local recurrence but associated with longer operative time and increased risk of gastric perfusion 48. Nevertheless, previous meta-analyses failed to report the summary analysis based on disease status, as well as whether the effectiveness of ESD versus EMR differed in view to other factors.…”