title: Outcome of endoscopic submucosal dissection for early gastric cancer of conventional and expanded indications: systematic review and meta-analysis.
abstract: OBJECTIVE
  Current guidelines for treating early gastric cancer (EGC) with endoscopic submucosal dissection (ESD) are being developed with broader criteria. This systematic review and meta-analysis aimed to assess the application of expanded indications (EIN) by comparing outcomes between conventional indication (CIN) and EIN groups.
  
  
  METHODS
  Literature databases were searched. Short-term outcomes, including endoscopic resection rates, complications and local recurrence, and long-term outcomes including gastric cancer-specific mortality and overall mortality were compared in the two groups.
  
  
  RESULTS
  In all, 13 studies were identified and evaluated. The EIN group had lower rates of en bloc (93.6% vs 97.0%, P < 0.0001), complete (87.8% vs 95.8%, P < 0.00001) and curative resection (82.4% vs 94.0%, P < 0.00001) than the CIN group. The rates of delayed bleeding and perforation were both significantly higher in the EIN group (3.9% vs 2.8%, P = 0.04 and 3.9% vs 1.8%, P < 0.0001). Local recurrence rates were 0.6% in the CIN group and 1.5% in the EIN group (P = 0.03). There were no significant differences between the two groups in the gastric-cancer specific mortality (P = 0.22) and the overall mortality (P = 0.37).
  
  
  CONCLUSIONS
  Long-term mortality in the EIN group did not significantly differ from those in the CIN group, although the EIN group was associated with more unfavorable short-term outcomes. Thus, ESD could be recommended as an effective therapy for EGC of EIN.
authors.affiliation: Department of Gastroenterology, Linyi People's Hospital Affiliated to Shandong University, Linyi, Shandong Province, China.
authors.forename: Li Jun
authors.initials: LJ
authors.lastname: Peng
authors.forename: Shu Ni
authors.initials: SN
authors.lastname: Tian
authors.forename: Lin
authors.initials: L
authors.lastname: Lu
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.forename: Yang Yang
authors.initials: YY
authors.lastname: Ouyang
authors.forename: Yu Jing
authors.initials: YJ
authors.lastname: Wu
mesh_terms: D004210:Dissection; D061345:Early Medical Intervention / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: conventional indication; early gastric cancer; endoscopic submucosal dissection; expanded indication; treatment outcome