Endoscopic submucosal dissection vs endoscopic mucosal resection for superficial esophageal cancer.
OBJECTIVE
To investigate the effectiveness of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) in treating superficial esophageal cancer (SEC).


METHODS
Studies investigating the safety and efficacy of ESD and EMR for SEC were searched from the databases of Pubmed, Web of Science, EMBASE and the Cochrane Library. Primary end points included the en bloc resection rate and the curative resection rate. Secondary end points included operative time, rates of perforation, postoperative esophageal stricture, bleeding and local recurrence. The random-effect model and the fixed-effect model were used for statistical analysis.


RESULTS
Eight studies were identified and included in the meta-analysis. As shown by the pooled analysis, ESD had significantly higher en bloc and curative resection rates than EMR. Local recurrence rate in the ESD group was remarkably lower than that in the EMR group. However, operative time and perforation rate for ESD were significantly higher than those for EMR. As for the rate of postoperative esophageal stricture and procedure-related bleeding, no significant difference was found between the two techniques.


CONCLUSIONS
ESD seems superior to EMR in the treatment of SEC as evidenced by significantly higher en bloc and curative resection rates and by obviously lower local recurrence rate.
Hui-Min Guo, Xiao-Qi Zhang, Min Chen, Shu-Ling Huang, Xiao-Ping Zou, Department of Gastroenterology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China.
Hui-Min
HM
Guo
Hui-Min Guo, Xiao-Qi Zhang, Min Chen, Shu-Ling Huang, Xiao-Ping Zou, Department of Gastroenterology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China.
Xiao-Qi
XQ
Zhang
Hui-Min Guo, Xiao-Qi Zhang, Min Chen, Shu-Ling Huang, Xiao-Ping Zou, Department of Gastroenterology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China.
Min
M
Chen
Hui-Min Guo, Xiao-Qi Zhang, Min Chen, Shu-Ling Huang, Xiao-Ping Zou, Department of Gastroenterology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China.
Shu-Ling
SL
Huang
Hui-Min Guo, Xiao-Qi Zhang, Min Chen, Shu-Ling Huang, Xiao-Ping Zou, Department of Gastroenterology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China.
Xiao-Ping
XP
Zou
D016063:Blood Loss, Surgical; D016009:Chi-Square Distribution; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004939:Esophageal Perforation / Q000209:etiology; D004940:Esophageal Stenosis / Q000209:etiology; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods*; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D006801:Humans; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D061646:Operative Time; D019106:Postoperative Hemorrhage / Q000209:etiology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
Endoscopic mucosal resection; Endoscopic submucosal dissection; Meta-analysis; Superficial esophageal cancer