Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: A meta-analysis.
OBJECTIVE
To compare endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early gastric cancer (EGC).


METHODS
Computerized bibliographic search was performed on PubMed/Medline, Embase, Google Scholar and Cochrane library databases. Quality of each included study was assessed according to current Cochrane guidelines. Primary endpoints were en bloc resection rate and histologically complete resection rate. Secondary endpoints were length of procedure, post-treatment bleeding, post-procedural perforation and recurrence rate. Comparisons between the two treatment groups across all the included studies were performed by using Mantel-Haenszel test for fixed-effects models (in case of low heterogeneity) or DerSimonian and Laird test for random-effects models (in case of high heterogeneity).


RESULTS
Ten retrospective studies (8 full text and 2 abstracts) were included in the meta-analysis. Overall data on 4328 lesions, 1916 in the ESD and 2412 in the EMR group were pooled and analyzed. The mean operation time was longer for ESD than for EMR (standardized mean difference 1.73, 95%CI: 0.52-2.95, P = 0.005) and the "en bloc" and histological complete resection rates were significantly higher in the ESD group [OR = 9.69 (95%CI: 7.74-12.13), P < 0.001 and OR = 5.66, (95%CI: 2.92-10.96), P < 0.001, respectively]. As a consequence of its greater radicality, ESD provided lower recurrence rate [OR = 0.09, (95%CI: 0.05-0.17), P < 0.001]. Among complications, perforation rate was significantly higher after ESD [OR = 4.67, (95%CI, 2.77-7.87), P < 0.001] whereas the bleeding incidences did not differ between the two techniques [OR = 1.49 (0.6-3.71), P = 0.39].


CONCLUSIONS
In the endoscopic therapy of EGC, ESD showed a superior efficacy but higher complication rate with respect to EMR.
Antonio Facciorusso, Matteo Antonino, Marianna Di Maso, Nicola Muscatiello, Gastroenterology Section, Department of Medical Sciences, University of Foggia, 71100 Foggia, Italy.
Antonio
A
Facciorusso
Antonio Facciorusso, Matteo Antonino, Marianna Di Maso, Nicola Muscatiello, Gastroenterology Section, Department of Medical Sciences, University of Foggia, 71100 Foggia, Italy.
Matteo
M
Antonino
Antonio Facciorusso, Matteo Antonino, Marianna Di Maso, Nicola Muscatiello, Gastroenterology Section, Department of Medical Sciences, University of Foggia, 71100 Foggia, Italy.
Marianna
M
Di Maso
Antonio Facciorusso, Matteo Antonino, Marianna Di Maso, Nicola Muscatiello, Gastroenterology Section, Department of Medical Sciences, University of Foggia, 71100 Foggia, Italy.
Nicola
N
Muscatiello
Early gastric cancer; Endoscopic mucosal resection; Endoscopic submucosal dissection; Meta-analysis