title: Evaluation of the Expanded Criteria of Endoscopic Submucosal Dissection for Early Gastric Cancers: A Meta-Analysis.
abstract: BACKGROUND
  In 2010, undifferentiated early-stage gastric cancers (EGCs; ≤1 cm and confined to the mucosa) were included in the expanded criteria for endoscopic submucosal dissection (ESD), as established by the Japanese Gastric Cancer Association.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of the newly expanded criteria of ESD for EGCs.
  
  
  METHODS
  PubMed, Embase, and the Cochrane Library were searched for relevant studies published between January 1, 2010 and July 10, 2014. These studies were collected by 2 authors and then analyzed with RevMan 5.0.
  
  
  RESULTS
  Six studies including 6,687 patients were identified. Compared to the standard group (SG), the expanded group (EG) had higher bleeding (OR 1.66; 95% CI 1.02-2.68), perforation (OR 2.03; 95% CI 1.25-3.31), positive lateral margin rates (OR 16.88; 95% CI 3.83-74.5) and lower en bloc resection rate (OR 0.48; 95% CI 0.34-0.70). The local recurrence (OR 2.46; 95% CI 0.31-19.23) and total survival rates (OR 0.92; 95% CI 0.76-1.12) between the 2 groups were not statistically different.
  
  
  CONCLUSIONS
  Considering the similar rates of local recurrence and total survival between the SG and EG, the use of ESD for the management of EGCs that meet the expanded criteria could be considered a safe and effective treatment method.
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Shangcheng District, Hangzhou, Zhejiang, PR China.
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Dai
authors.forename: Xuan
authors.initials: X
authors.lastname: Huang
authors.forename: Bin
authors.initials: B
authors.lastname: Lu
authors.forename: Haifeng
authors.initials: H
authors.lastname: Jin
authors.forename: Lina
authors.initials: L
authors.lastname: Meng
mesh_terms: D000368:Aged; D004210:Dissection / Q000592:standards*; D055088:Early Detection of Cancer / Q000592:standards*; D016099:Endoscopy, Gastrointestinal / Q000592:standards*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome