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Efficacy and safety of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors: a systematic review and meta-analysis

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Abstract

Background

In recent years, submucosal tunneling endoscopic resection (STER) has emerged as a novel therapeutic endoscopic technique for upper gastrointestinal submucosal tumors (SMTs). The aim of this study was to evaluate the safety and efficacy of STER for upper gastrointestinal SMTs.

Methods

A systematic search of both English and Chinese databases was performed until November 15, 2015. Complete resection and en bloc resection rates were considered the primary outcome measures. Prevalence of complications was considered the secondary outcome measure. A random-effects model was used to generate conservative estimates of the prevalence of the main outcome variables. All data analyses were performed using Meta-Analyst software (version beta 3.13).

Results

A total of 28 studies were included in the final meta-analysis. The pooled complete resection and en bloc resection rates were 97.5 % (95 % CI 96.0–98.5 %) and 94.6 % (95 % CI 91.5–96.7 %), respectively. The common complications associated with STER were air leakage symptoms and perforation. The pooled prevalence of air leakage symptoms was 14.8 % (95 % CI 10.5–20.5 %) for subcutaneous emphysema and pneumomediastinum, 6.1 % (95 % CI 4.0–9.0 %) for pneumothorax and 6.8 % (95 % CI 4.7–9.6 %) for pneumoperitoneum. Additionally, the pooled prevalence of perforation was 5.6 % (95 % CI 3.7–8.2 %). Only a few cases of bleeding were reported in two studies.

Conclusions

STER is a highly feasible and safe treatment option for upper gastrointestinal SMTs.

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Abbreviations

STER:

Submucosal tunneling endoscopic resection

SMTs:

Submucosal tumors

SEP:

Subcutaneous emphysema and pneumomediastinum

GIST:

Gastrointestinal stromal tumor

GCT:

Granular cell tumor

CFT:

Calcifying fibrous tumor

EUS:

Endoscopic ultrasonography

MP:

Muscularis propria

ESE:

Endoscopic submucosal excavation

EFR:

Endoscopic full-thickness resection

POEM:

Peroral endoscopic myotomy

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Authors and Affiliations

  1. Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, Sichuan, China

    Xiu-He Lv, Chun-Hui Wang & Yan Xie

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  1. Xiu-He Lv
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  2. Chun-Hui Wang
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Correspondence to Yan Xie.

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Drs. Xiu-He Lv, Chun-Hui Wang and Yan Xie have no conflicts of interest or financial ties to disclose.

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Lv, XH., Wang, CH. & Xie, Y. Efficacy and safety of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors: a systematic review and meta-analysis. Surg Endosc 31, 49–63 (2017). https://doi.org/10.1007/s00464-016-4978-7

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