title: Endoscopic and oncologic outcomes according to indication criteria of endoscopic resection for early gastric cancer: a systematic review and meta-analysis.
abstract: BACKGROUND
  The criteria for endoscopic resection for early gastric cancer (EGC) have been expanded recently, and it has become acceptable to use techniques that are regarded as having equivalent technical and pathological outcomes to absolute indication (AI). However, the long-term oncological outcomes of expanded indication (EI) have yet to be clarified. This meta-analysis aimed to assess the long-term outcome of EI versus AI, to identify the endoscopic feasibility and safety according to the indication, and to provide the appropriate recommendations for each indication.
  
  
  METHODS
  Electronic databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and KoreaMed were searched for articles published between January 2000 and October 2014. After screening, the reviewers extracted the information from 12 retrospective cohort studies. A total of 9635 EGC lesions, 4150 lesions in the EI group and 5485 lesions in the AI group, were included in this study.
  
  
  RESULTS
  Meta-analyses showed that the local recurrence rate [risk ratio (RR) 1.34; 95% CI 0.67-2.70] was not significantly higher in the EI group compared with the AI group, although the metachronous recurrence rate was higher in the EI group than in the AI group (RR 1.60; 95% CI 1.22-2.10). The rates of en bloc resection [odds ratio (OR) 0.57; 95% CI 0.41-0.78), complete resection (OR 0.37; 95% CI 0.25-0.57), and curative resection (OR 0.34; 95% CI 0.20-0.58) were significantly inferior in the EI group than in the AI group, whereas overall bleeding risk (RR 1.47; 95% CI 1.19-1.82) and procedure-related perforation rate (OR 2.04; 95% CI 1.56-2.68) were significantly higher in the EI group than in the AI group.
  
  
  CONCLUSIONS
  This meta-analysis suggests that the EI group showed acceptable long-term outcomes with local recurrence rate that was not significantly inferior, although the metachronous recurrence rate was higher compared with that in the AI group.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Seoku-dong, Hwaseong-si, Gyeonggi-do, 445-907, Korea.
authors.forename: Se Woo
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. leehyuk@skku.edu.
authors.forename: Hyuk
authors.initials: H
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Gyeonggi-do, Korea.
authors.forename: Chan Hyuk
authors.initials: CH
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Seoku-dong, Hwaseong-si, Gyeonggi-do, 445-907, Korea. jhj1229@hallym.or.kr.
authors.forename: Hyun Joo
authors.initials: HJ
authors.lastname: Jang
authors.affiliation: Department of Statistics, Dongguk University, Seoul, Korea.
authors.forename: Hongyup
authors.initials: H
authors.lastname: Ahn
mesh_terms: D055088:Early Detection of Cancer; D005773:Gastroscopy; D006801:Humans; D009364:Neoplasm Recurrence, Local; D013274:Stomach Neoplasms / Q000601:surgery*
keywords: Early gastric cancer; Endoscopic resection; Indication; Meta-analysis; Systematic review