Endoscopic submucosal dissection of gastric subepithelial tumors: a systematic review and meta-analysis

Chang Seok Bang, Gwang Ho Baik, In Soo Shin, Ki Tae Suk, Jai Hoon Yoon, Dong Joon Kim, Chang Seok Bang, Gwang Ho Baik, In Soo Shin, Ki Tae Suk, Jai Hoon Yoon, Dong Joon Kim

Abstract

Background/aims: To evaluate the therapeutic outcomes of the endoscopic submucosal dissection (ESD) technique for the treatment of gastric subepithelial tumors (SETs).

Methods: A systematic literature review was conducted using the core databases. Data on the complete resection rates and the procedure-related perforation rates were extracted and analyzed. A random effects model was then applied for this meta-analysis.

Results: In all, 288 patients with 290 SETs were enrolled from nine studies (44 SETs originated from the submucosal layer; 246 SETs originated from the muscularis propria layer). The mean diameter of the lesions ranged from 17.99 to 38 mm. Overall, the pooled complete resection rate was estimated to be 86.2% (95% confidence interval [CI], 78.9 to 91.3). If the analysis was limited to the lesions that originated from the submucosal layer, the pooled complete resection rate was 91.4% (95% CI, 77.9 to 97). If the analysis was limited to the lesions that originated from the muscularis propria, the pooled complete resection rate was 84.4% (95% CI, 78.7 to 88.8). The pooled procedure-related gastric perforation rate was 13% (95% CI, 9.4 to 17.6). Sensitivity analyses showed consistent results. Finally, publication bias was not detected.

Conclusions: ESD, including endoscopic muscularis dissection, is a technically feasible procedure for the treatment of SETs. However, selection bias is suspected from the enrolled studies. For the development of a proper indication of ESD for SETs, further studies are needed.

Keywords: Endoscopic submucosal dissection; Gastrointestinal stromal tumors; Subepithelial tumors.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Flow diagram for identification of relevant studies.
Figure 2.
Figure 2.
Total complete resection rate of enrolled studies. The size of each square is proportional to the study’s weight. Diamond is the summary estimate from the pooled studies (random effect model). CI, confidence interval.
Figure 3.
Figure 3.
Total procedure-related adverse event rate of enrolled studies (gastric perforation). The size of each square is proportional to the study’s weight. Diamond is the summary estimate from the pooled studies (random effect model). CI, confidence interval.
Figure 4.
Figure 4.
Sensitivity analysis. (A) Complete resection rate of lesions originated from the submucosal layer. (B) Complete resection rate of lesions originated from the muscularis propria layer. (C) Complete resection rate of gastrointestinal stromal tumor (GIST). (D) Total procedure-related gastric perforation rate of GIST. CI, confidence interval.
Figure 5.
Figure 5.
Cumulative meta-analysis of enrolled studies. (A) For complete resection rate. (B) For procedure-related adverse event rate of enrolled studies (gastric perforation). CI, confidence interval.
Figure 6.
Figure 6.
One study removed meta-analysis of enrolled studies. (A) For complete resection rate. (B) For procedure-related adverse event rate of enrolled studies (gastric perforation). CI, confidence interval.
Figure 7.
Figure 7.
Funnel plot for publication bias. (A) Complete resection rate. (B) Funnel plot for publication bias (procedure-related adverse event rate; gastric perforation).

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Source: PubMed

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