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Endoscopic submucosal tunnel dissection for superficial esophageal neoplastic lesions: a meta-analysis

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Abstract

Background and aims

The emerging endoscopic submucosal tunnel dissection (ESTD) is becoming an alternative method for superficial esophageal neoplastic lesions. This study aimed to evaluate the effectiveness and feasibility of ESTD for superficial esophageal neoplastic lesions.

Methods

A comprehensive literature review was conducted to search relevant studies through PubMed, EMBASE, Cochrane Library, and Web of Science before 1 December 2018. Studies relating to ESTD for superficial esophageal neoplastic lesions were included. Rates of effectiveness (en bloc resection rate, R0 resection rate, and curative resection rate), rates of feasibility (muscular damage rate, perforation rate, postprocedural bleeding rate, and emphysema rate), and rates of follow-up (recurrence rate and stricture rate) were pooled and analyzed. Forest plots were constructed based on the random-effects model. Sensitivity analyses were also performed if significant heterogeneity existed.

Results

Six studies including 414 patients and 436 superficial esophageal neoplastic lesions that underwent ESTD were available for analysis. The pooled estimates of en bloc resection rate, R0 resection rate, and curative resection rate were 98% (95% CI 95.8–99.0%), 87.0% (95% CI 78.2–92.5%), and 87.6% (95% CI 67.4–96.0%), respectively. The pooled outcomes of muscular damage rate, perforation rate, postprocedural bleeding rate and emphysema rate were 19.1% (95% CI 9.8–33.8%), 2.2% (95% CI 1.1–4.1%), 1.6% (95% CI 0.7–3.5%), and 12.2% (95% CI 4.3–29.9%), respectively. Finally, the pooled results of recurrence and stricture were 4.7% (0.9–20.5%) and 20.9% (11.3–35.2%), respectively.

Conclusions

ESTD appears to be an effective and feasible approach for treating superficial esophageal neoplastic lesions. However, future research is needed for new and comprehensive methods to decrease the stricture rate after ESTD.

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Acknowledgements

Special thanks to Dr. Bin Ma for his selfless teaching and help for Dr. Peiwen Li to conduct this study.

Funding

This study was supported by the Natural Science Foundation of Liaoning Province (Grant No. 2015020561), The Fund for Scientific Research of The First Hospital of China Medical University (Grant No. fsfh1514), and Wu Jieping Medical Foundation Grant No. 320.6750.18293).

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Authors and Affiliations

  1. Department of Thoracic Surgery, The First Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, People’s Republic of China

    Peiwen Li, Shulei Gong, Xinyu Zhang & Wenya Li

  2. Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People’s Republic of China

    Bin Ma

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  1. Peiwen Li
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  2. Bin Ma
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  5. Wenya Li
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Correspondence to Wenya Li.

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Disclosures

Dr. Peiwen Li, Dr. Bin Ma, Dr. Shulei Gong, Dr. Xinyu Zhang, and Dr. Wenya Li have no conflicts of interest or financial ties to disclose.

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Li, P., Ma, B., Gong, S. et al. Endoscopic submucosal tunnel dissection for superficial esophageal neoplastic lesions: a meta-analysis. Surg Endosc 34, 1214–1223 (2020). https://doi.org/10.1007/s00464-019-06875-y

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  • DOI: https://doi.org/10.1007/s00464-019-06875-y

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