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Efficacy of endoscopic submucosal tunnel dissection versus endoscopic submucosal dissection for superficial esophageal neoplastic lesions: a systematic review and meta-analysis

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Abstract

Background

To evaluate the effectiveness of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection (ESD) in superficial esophageal neoplastic lesions (SENL).

Methods

A comprehensive search for studies investigating the efficacy of ESTD and ESD for SENL was conducted to search for relevant studies through PubMed, Web of Science, Cochrane Library, SinoMed, CNKI, and Wanfang. Weighted pooled rates were calculated for en bloc resection rate, R0 resection rate, operation time, dissection area, dissection speed, and adverse events. The 95% confidence intervals (95%CI) for effect size were used to calculate the pooled value using the fixed- or random-effects model.

Results

A total of seventeen studies with 1161 patients were identified and included in the meta-analysis. The pooled analysis showed that ESTD had significantly higher en bloc resection (OR 3.98; 95% CI 1.74 to 9.12; p = 0.001) and R0 resection rates (OR 2.29; 95% CI 1.54 to 3.46; p < 0.001) than ESD. The operation time in the ESTD group was shorter than that in the ESD group (SMD = − 0.57; 95% CI − 0.95 to − 0.19; p = 0.003). The dissection area of the ESTD group was larger than that in the ESD group (SMD = 0.49; 95% CI 0.16 to 0.83; p = 0.004), and the dissection speed is faster than that in the ESD group (SMD = 1.52; 95%CI 1.09 to 0.83; p < 0.001). There were no significant differences in esophageal stenosis (p = 0.94) between the two techniques. However, ESTD was superior to ESD in other adverse events (p < 0.05).

Conclusion

ESTD has a significant advantage over ESD in the treatment of SENL. ESTD has significantly higher en bloc and R0 resection rates and reduced adverse events.

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References

  1. Pioche M, Mais L, Guillaud O (2013) Endoscopic submucosal tunnel dissection for large esophageal neoplastic lesions. Endoscopy 45:1032–1034

    Article  Google Scholar 

  2. Gan T, Yang JL, Zhu LL (2016) Endoscopic submucosal multi-tunnel dissection for circumferential superficial esophageal neoplastic lesions (with videos). Gastrointest Endosc 84:143–146

    Article  Google Scholar 

  3. Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T (2015) Endoscopic submucosal dissection: European Society of Gastrointestinal endoscopy (ESGE) guideline. Endoscopy 47:829–854

    Article  Google Scholar 

  4. Fujiya M, Tanaka K, Dokoshi T (2015) Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 81:583–595

    Article  Google Scholar 

  5. Guo HM, Zhang XQ, Chen M (2014) Endoscopic submucosal dissection vs endoscopic mucosal resection for superficial esophageal cancer. World J Gastroenterol 20:5540–5547

    Article  Google Scholar 

  6. Yu X, Chen J, Yuan Z (2020) Endoscopic resection techniques for squamous premalignant lesions and early carcinoma of the esophagus: ER-Cap, MBM, and ESD, how do we choose? A multicenter experience. Therap Adv Gastroenterol 13:562–574

    Google Scholar 

  7. Ishihara R, Arima M, Iizuka T (2020) Endoscopic submucosal dissection/endoscopic mucosal resection guidelines for esophageal cancer. Dig Endosc 19:125–141

    Google Scholar 

  8. Saftoiu A, Hassan C, Areia M (2020) Role of gastrointestinal endoscopy in the screening of digestive tract cancers in Europe: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy 52:293–304

    Article  Google Scholar 

  9. Li P, Ma B, Gong S (2020) Endoscopic submucosal tunnel dissection for superficial esophageal neoplastic lesions: a meta-analysis. Surg Endosc 34:1214–1223

    Article  Google Scholar 

  10. Aslanian HR, Sethi A, Bhutani MS (2019) ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection. VideoGIE 4:343–350

    Article  Google Scholar 

  11. Zhai Y, Linghu E, Li H (2014) Comparison of endoscopic submucosal tunnel dissection with endoscopic submucosal dissection for large esophageal superficial neoplasms. Nan Fang Yi Ke Da Xue Xue Bao 34:36–40

    PubMed  Google Scholar 

  12. Li Y, Wang K, Shi Y (2019) Comparison of short-term efficacy between endoscopic submucosal tunnel dissection and endoscopic submucosal dissection in treatment of wide esophageal squamous cell carcinoma of early stage. J Clin Gastroenterol 54(6):512–516

    Google Scholar 

  13. Gong J, Zhou BY, Liang CB (2019) Comparison between tunneling and standard endoscopic submucosal dissection for treatment of large esophageal superficial neoplasm. Acta Gastroenterol Belg 82:469–474

    CAS  PubMed  Google Scholar 

  14. Huang R, Cai H, Zhao X (2017) Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal squamous cell carcinoma: a propensity score matching analysis. Gastrointest Endosc 86:831–838

    Article  Google Scholar 

  15. Zhang W, Zhai Y, Chai N (2018) Endoscopic submucosal tunnel dissection and endoscopic submucosal dissection for large superficial esophageal squamous cell neoplasm: efficacy and safety study to guide future practice. Surg Endosc 32:2814–2821

    Article  Google Scholar 

  16. Wei L, Lixia X, Wanying D (2015) Clinical value of endoscopic submucosal eunnel dissection and endoscopic submucosal dissection for early esophageal cancer and precancerous lesions. J Fujian Med Univ 49:96–100

    Google Scholar 

  17. Wang J, Qin JY, Guo TJ (2015) The efficiency and complications of ESD and ESTD in the treatment of large esophageal mucosal lesions. Sichuan Da Xue Xue Bao Yi Xue Ban 46:896–900

    PubMed  Google Scholar 

  18. Zhang X, Feng K, Zhu J (2015) Research on effect of endoscopic submucosal tunnel dissection on patients with large esophageal superficial neoplasms. China Med Equip 12:125–127

    Google Scholar 

  19. Chen L, Wang L, Gao S (2016) Effects of endoscopic submucosal tunnel dissection for esophageal superficial neoplasms. Chin J Laparosc Surg (Electr Edit) 9:243–247

    Google Scholar 

  20. Yang J (2016) Effect and safety of endoscopic submucosal tunnel dissection in the treatment of large esophageal superficial neoplasms. Shanghai Med Pharma J 37:30–32

    Google Scholar 

  21. Huang R, Zhao X, Lu X (2018) Comparison of endoscopic submucosal tunnel dissection with endoscopic submucosal dissection for esophageal superficial neoplasms: a retrospective study. Chin J Dig Endosc 35:229–233

    Google Scholar 

  22. Jin X, Qi X (2018) Comparative analysis between endoscopic submucosal dissection and endoscopic submucosal tunnel dissection in treatment of patients with early esophageal cancer and precancerous Lesions. Med Pharma J Chin People's Liberat Arm 30:16–19

    Google Scholar 

  23. Zhou W (2018) Comparison of efficacy and safety of two different mucosal dissection for the treatment of extensive superficial esophageal tumors. Mod Dig Intervent 23:140–141

    Google Scholar 

  24. Wang F, Wang S, Zeng D (2018) Effect of endoscopic subnmeosal tunnel dissection in treatment of early esophageal cancer and esophageal precancerous lesions. Med Innovat China 15:89–92

    Google Scholar 

  25. Qiao X, Liang F, Liu S (2019) Value of endoscopic submucosal tunnel resection of large area esophageal mucosal lesions. Chin J Dig Med Imageol (Elect Edit) 9:61–64

    Google Scholar 

  26. Yuxin W, Jijun Z, Yunyun L (2019) Endoscopic submucosal dissection for treatment of patients with esophageal intramucosal and submucosal cancer: efficacy and factors in?uencing operative time. Chin J Clin (Electr Edit) 13:675–679

    Google Scholar 

  27. Jingyuan X, Enqiang L, Longsong L (2019) Safety and efficacy of endoscopic submucosal tunnel dissection for large early esophageal cancer. Chin J Laparosc Surg (Electr Edit) 12:272–276

    Google Scholar 

  28. Marc G, Lopes CV (2008) Endoscopic resection of superficial gastrointestinal tumors. World J Gastroenterol 14:4600–4606

    Article  Google Scholar 

  29. Xia M, Zhou Y, Yu J (2019) Short-term outcomes of traction-assisted versus conventional endoscopic submucosal dissection for superficial gastrointestinal neoplasms: a systematic review and meta-analysis of randomized controlled studies. World J Surg Oncol 17:94–106

    Article  Google Scholar 

  30. Oyama T (2014) Esophageal ESD: technique and prevention of complications. Gastrointest Endosc Clin N Am 24:201–212

    Article  Google Scholar 

  31. Akahoshi K, Akahane H (2010) A new breakthrough: ESD using a newly developed grasping type scissor forceps for early gastrointestinal tract neoplasms. World J Gastrointest Endosc 2:90–96

    Article  Google Scholar 

  32. von Delius S, Feussner H, Henke J (2007) Submucosal endoscopy: a novel approach to en bloc endoscopic mucosal resection (with videos). Gastrointest Endosc 66:753–756

    Article  Google Scholar 

  33. Linghu E, Feng X, Wang X (2013) Endoscopic submucosal tunnel dissection for large esophageal neoplastic lesions. Endoscopy 45:60–62

    CAS  PubMed  Google Scholar 

  34. Zhang W, Zhai Y, Chai N (2018) Single- and double-tunnel endoscopic submucosal tunnel dissection for large superficial esophageal squamous cell neoplasms. Endoscopy 50:505–510

    Article  CAS  Google Scholar 

  35. Cai MY, Zhu Y, Zhou PH (2019) Endoscopic minimally invasive treatment—from inside the lumen to outside the lumen, from the superficial layer to the deep layer. Zhonghua Wei Chang Wai Ke Za Zhi 22:601–608

    CAS  PubMed  Google Scholar 

  36. Chai NL, Li HK, Linghu EQ (2019) Consensus on the digestive endoscopic tunnel technique. World J Gastroenterol 25:744–776

    Article  Google Scholar 

  37. Miwata T, Oka S, Tanaka S (2016) Risk factors for esophageal stenosis after entire circumferential endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Surg Endosc 30:4049–4056

    Article  Google Scholar 

  38. Chen M, Dang Y, Ding C (2020) Lesion size and circumferential range identified as independent risk factors for esophageal stricture after endoscopic submucosal dissection. Surg Endosc 2:115–131

    Google Scholar 

  39. Tang X, Ren Y, Huang S (2017) Endoscopic submucosal tunnel dissection for upper gastrointestinal submucosal tumors originating from the muscularis propria layer: a single-center study. Gut Liver 11:620–627

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank Dr. Yang, an expert clinical epidemiologist, for his assistance with methodology of the research and Ms. Li, the library administrator of Southwestern Medical University, for her assistance with the search strategies.

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Author notes

  1. Ting Zhang and Hao Zhang have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, 25 Taiping street, Luzhou, Sichuan Province, 646000, People’s Republic of China

    Ting Zhang & Xuan Wang

  2. Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, People’s Republic of China

    Hao Zhang & Furui Zhong

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  1. Ting Zhang
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  2. Hao Zhang
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  3. Furui Zhong
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  4. Xuan Wang
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Correspondence to Xuan Wang.

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Ting Zhang, Hao Zhang, Furui Zhong, and Xuan Wang have no conflicts of interest or financial ties to disclose.

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Zhang, T., Zhang, H., Zhong, F. et al. Efficacy of endoscopic submucosal tunnel dissection versus endoscopic submucosal dissection for superficial esophageal neoplastic lesions: a systematic review and meta-analysis. Surg Endosc 35, 52–62 (2021). https://doi.org/10.1007/s00464-020-07925-6

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  • DOI: https://doi.org/10.1007/s00464-020-07925-6

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