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

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus

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.
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f5-kjim-2015-093: 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.

Mentions: The cumulative meta-analysis of the enrolled studies in the order of year published showed a constant and slightly increasing trend in the complete resection rate and the procedure-related gastric perforation rate (Fig. 5). The one study-removed meta-analysis of the enrolled studies in the order of the year published showed consistent results (Fig. 6). The study by He et al. [24] demonstrated the most influential effect. This study has the largest enrolled population, and the methodological quality was relatively high among the enrolled studies.


Endoscopic submucosal dissection of gastric subepithelial tumors: a systematic review and meta-analysis
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.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016280&req=5

f5-kjim-2015-093: 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.
Mentions: The cumulative meta-analysis of the enrolled studies in the order of year published showed a constant and slightly increasing trend in the complete resection rate and the procedure-related gastric perforation rate (Fig. 5). The one study-removed meta-analysis of the enrolled studies in the order of the year published showed consistent results (Fig. 6). The study by He et al. [24] demonstrated the most influential effect. This study has the largest enrolled population, and the methodological quality was relatively high among the enrolled studies.

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus