Endoscopic submucosal dissection of gastric tumors: A systematic review and meta-analysis.
OBJECTIVE
To systematically review the medical literature in order to evaluate the safety and efficacy of gastric endoscopic submucosal dissection (ESD).


METHODS
We performed a comprehensive literature search of MEDLINE, Ovid, CINAHL, and Cochrane for studies reporting on the clinical efficacy and safety profile of gastric ESD.


RESULTS
Twenty-nine thousand five hundred and six tumors in 27155 patients (31% female) who underwent gastric ESD between 1999 and 2014 were included in this study. R0 resection rate was 90% (95%CI: 87%-92%) with significant between-study heterogeneity (P < 0.001) which was partly explained by difference in region (P = 0.02) and sample size (P = 0.04). Endoscopic en bloc and curative resection rates were 94% (95%CI: 93%-96%) and 86% (95%CI: 83%-89%) respectively. The rate of immediate and delayed perforation rates were 2.7% (95%CI: 2.1%-3.3%) and 0.39% (95%CI: 0.06%-2.4%) respectively while rates of immediate and delayed major bleeding were 2.9% (95%CI: 1.3-6.6) and 3.6% (95%CI: 3.1%-4.3%). After an average follow-up of about 30 mo post-operative, the rate of tumor recurrence was 0.02% (95%CI: 0.001-1.4) among those with R0 resection and 7.7% (95%CI: 3.6%-16%) among those without R0 resection. Overall, irrespective of the resection status, recurrence rate was 0.75% (95%CI: 0.42%-1.3%).


CONCLUSIONS
Our meta-analysis, the largest and most comprehensive assessment of gastric ESD till date, showed that gastric ESD is safe and effective for gastric tumors and warrants consideration as first line therapy when an expert operator is available.
Emmanuel Akintoye, Arunkumar Muthusamy, Diane Levine, Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI 48201, United States.
Emmanuel
E
Akintoye
Emmanuel Akintoye, Arunkumar Muthusamy, Diane Levine, Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI 48201, United States.
Itegbemie
I
Obaitan
Emmanuel Akintoye, Arunkumar Muthusamy, Diane Levine, Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI 48201, United States.
Arunkumar
A
Muthusamy
Emmanuel Akintoye, Arunkumar Muthusamy, Diane Levine, Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI 48201, United States.
Olalekan
O
Akanbi
Emmanuel Akintoye, Arunkumar Muthusamy, Diane Levine, Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI 48201, United States.
Mayowa
M
Olusunmade
Emmanuel Akintoye, Arunkumar Muthusamy, Diane Levine, Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI 48201, United States.
Diane
D
Levine
Endoscopic submucosal dissection; Gastric neoplasms; Meta-analysis