title: Endoscopic submucosal dissection of gastric subepithelial tumors: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the therapeutic outcomes of the endoscopic submucosal dissection (ESD) technique for the treatment of gastric subepithelial tumors (SETs).
  
  
  METHODS
  A systematic literature review was conducted using the core databases. Data on the complete resection rates and the procedure-related perforation rates were extracted and analyzed. A random effects model was then applied for this meta-analysis.
  
  
  RESULTS
  In all, 288 patients with 290 SETs were enrolled from nine studies (44 SETs originated from the submucosal layer; 246 SETs originated from the muscularis propria layer). The mean diameter of the lesions ranged from 17.99 to 38 mm. Overall, the pooled complete resection rate was estimated to be 86.2% (95% confidence interval [CI], 78.9 to 91.3). If the analysis was limited to the lesions that originated from the submucosal layer, the pooled complete resection rate was 91.4% (95% CI, 77.9 to 97). If the analysis was limited to the lesions that originated from the muscularis propria, the pooled complete resection rate was 84.4% (95% CI, 78.7 to 88.8). The pooled procedure-related gastric perforation rate was 13% (95% CI, 9.4 to 17.6). Sensitivity analyses showed consistent results. Finally, publication bias was not detected.
  
  
  CONCLUSIONS
  ESD, including endoscopic muscularis dissection, is a technically feasible procedure for the treatment of SETs. However, selection bias is suspected from the enrolled studies. For the development of a proper indication of ESD for SETs, further studies are needed.
authors.affiliation: Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
authors.forename: Chang Seok
authors.initials: CS
authors.lastname: Bang
authors.affiliation: Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
authors.forename: Gwang Ho
authors.initials: GH
authors.lastname: Baik
authors.affiliation: Jeonju University College of Education, Jeonju, Korea.
authors.forename: In Soo
authors.initials: IS
authors.lastname: Shin
authors.affiliation: Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Suk
authors.affiliation: Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
authors.forename: Jai Hoon
authors.initials: JH
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
mesh_terms: D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005240:Feasibility Studies; D005753:Gastric Mucosa / Q000601:surgery; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery; D006801:Humans; D009375:Neoplasms, Glandular and Epithelial / Q000601:surgery; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Endoscopic submucosal dissection; Gastrointestinal stromal tumors; Subepithelial tumors