The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: A systematic review and metaanalysis

Young Mi Park, Eun Cho, Hye Young Kang, Jong Mann Kim

Research output: Contribution to journalReview article

182 Citations (Scopus)

Abstract

Background: Endoscopic submucosal dissection (ESD) allows en bloc resection of the entire lesion, permitting a higher curative resection rate and increased quality of life by minimizing the resection size compared with that of endoscopic mucosal resection (EMR). Although ESD has been implemented at most university hospitals in Korea, potential complications of ESD such as bleeding and perforation raise doubts in the therapeutic decision on use of the ESD procedure for early gastric cancer patients and in reimbursement decision making. This systematic review aimed to address both the effectiveness and safety outcomes of ESD versus EMR for early gastric cancer. Methods: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Koreamed were searched using the primary keywords "stomach neoplasm" AND "endoscopic submucosal dissection" AND "endoscopic mucosal resection." To assess the quality of selected studies, the methodologic approach of the Scottish Intercollegiate Guidelines Network was used. Five effectiveness-relevant and three safety-relevant outcome measures were extracted. Bibliography management and metaanalysis for each outcome were conducted using Review Manager 5.0. Results: Three nonconcurrent cohort studies and nine retrospective cohort studies were identified. Metaanalyses showed ESD to be significantly more effective than EMR for en bloc resection (odds ratio [OR], 8.43; 95% confidence interval [CI], 5.20-13.67), complete resection (OR, 14.11; 95% CI, 10.85-18.35), curative resection (OR, 3.28; 95% CI, 1.95-5.54), and local recurrence (risk ratio [RR], 0.13; 95% CI, 0.04-0.41). Whereas intraoperative bleeding (RR, 2.16; 95% CI, 1.14-4.09), perforation risk (RR, 3.58; 95% CI, 1.95-6.55), and operation time (standard mean difference [SMD], 1.55; 95% CI, 0.74-2.37) were significantly greater for ESD, overall bleeding risk (RR, 1.22; 95% CI, 0.76-1.98) and all-cause mortality (RR, 0.65; 95% CI, 0.08-5.38) did not differ significantly between ESD and EMR. Conclusions: Considering that bleeding risk did not differ significantly between ESD and EMR and that perforation risk usually does not lead to life-threatening disease, the effectiveness benefit of ESD can outweigh the overall harm compared with EMR on the condition that ESD is performed by experienced practitioners.

Original languageEnglish
Pages (from-to)2666-2677
Number of pages12
JournalSurgical endoscopy
Volume25
Issue number8
DOIs
Publication statusPublished - 2011 Aug

Fingerprint

Stomach Neoplasms
Safety
Confidence Intervals
Odds Ratio
Hemorrhage
Endoscopic Mucosal Resection
Cohort Studies
Bibliography
Korea
MEDLINE

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

@article{7a8e006ef3fe4949b5456c1fc1c0ef22,
title = "The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: A systematic review and metaanalysis",
abstract = "Background: Endoscopic submucosal dissection (ESD) allows en bloc resection of the entire lesion, permitting a higher curative resection rate and increased quality of life by minimizing the resection size compared with that of endoscopic mucosal resection (EMR). Although ESD has been implemented at most university hospitals in Korea, potential complications of ESD such as bleeding and perforation raise doubts in the therapeutic decision on use of the ESD procedure for early gastric cancer patients and in reimbursement decision making. This systematic review aimed to address both the effectiveness and safety outcomes of ESD versus EMR for early gastric cancer. Methods: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Koreamed were searched using the primary keywords {"}stomach neoplasm{"} AND {"}endoscopic submucosal dissection{"} AND {"}endoscopic mucosal resection.{"} To assess the quality of selected studies, the methodologic approach of the Scottish Intercollegiate Guidelines Network was used. Five effectiveness-relevant and three safety-relevant outcome measures were extracted. Bibliography management and metaanalysis for each outcome were conducted using Review Manager 5.0. Results: Three nonconcurrent cohort studies and nine retrospective cohort studies were identified. Metaanalyses showed ESD to be significantly more effective than EMR for en bloc resection (odds ratio [OR], 8.43; 95{\%} confidence interval [CI], 5.20-13.67), complete resection (OR, 14.11; 95{\%} CI, 10.85-18.35), curative resection (OR, 3.28; 95{\%} CI, 1.95-5.54), and local recurrence (risk ratio [RR], 0.13; 95{\%} CI, 0.04-0.41). Whereas intraoperative bleeding (RR, 2.16; 95{\%} CI, 1.14-4.09), perforation risk (RR, 3.58; 95{\%} CI, 1.95-6.55), and operation time (standard mean difference [SMD], 1.55; 95{\%} CI, 0.74-2.37) were significantly greater for ESD, overall bleeding risk (RR, 1.22; 95{\%} CI, 0.76-1.98) and all-cause mortality (RR, 0.65; 95{\%} CI, 0.08-5.38) did not differ significantly between ESD and EMR. Conclusions: Considering that bleeding risk did not differ significantly between ESD and EMR and that perforation risk usually does not lead to life-threatening disease, the effectiveness benefit of ESD can outweigh the overall harm compared with EMR on the condition that ESD is performed by experienced practitioners.",
author = "Park, {Young Mi} and Eun Cho and Kang, {Hye Young} and Kim, {Jong Mann}",
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The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer : A systematic review and metaanalysis. / Park, Young Mi; Cho, Eun; Kang, Hye Young; Kim, Jong Mann.

In: Surgical endoscopy, Vol. 25, No. 8, 08.2011, p. 2666-2677.

Research output: Contribution to journalReview article

TY - JOUR

T1 - The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer

T2 - A systematic review and metaanalysis

AU - Park, Young Mi

AU - Cho, Eun

AU - Kang, Hye Young

AU - Kim, Jong Mann

PY - 2011/8

Y1 - 2011/8

N2 - Background: Endoscopic submucosal dissection (ESD) allows en bloc resection of the entire lesion, permitting a higher curative resection rate and increased quality of life by minimizing the resection size compared with that of endoscopic mucosal resection (EMR). Although ESD has been implemented at most university hospitals in Korea, potential complications of ESD such as bleeding and perforation raise doubts in the therapeutic decision on use of the ESD procedure for early gastric cancer patients and in reimbursement decision making. This systematic review aimed to address both the effectiveness and safety outcomes of ESD versus EMR for early gastric cancer. Methods: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Koreamed were searched using the primary keywords "stomach neoplasm" AND "endoscopic submucosal dissection" AND "endoscopic mucosal resection." To assess the quality of selected studies, the methodologic approach of the Scottish Intercollegiate Guidelines Network was used. Five effectiveness-relevant and three safety-relevant outcome measures were extracted. Bibliography management and metaanalysis for each outcome were conducted using Review Manager 5.0. Results: Three nonconcurrent cohort studies and nine retrospective cohort studies were identified. Metaanalyses showed ESD to be significantly more effective than EMR for en bloc resection (odds ratio [OR], 8.43; 95% confidence interval [CI], 5.20-13.67), complete resection (OR, 14.11; 95% CI, 10.85-18.35), curative resection (OR, 3.28; 95% CI, 1.95-5.54), and local recurrence (risk ratio [RR], 0.13; 95% CI, 0.04-0.41). Whereas intraoperative bleeding (RR, 2.16; 95% CI, 1.14-4.09), perforation risk (RR, 3.58; 95% CI, 1.95-6.55), and operation time (standard mean difference [SMD], 1.55; 95% CI, 0.74-2.37) were significantly greater for ESD, overall bleeding risk (RR, 1.22; 95% CI, 0.76-1.98) and all-cause mortality (RR, 0.65; 95% CI, 0.08-5.38) did not differ significantly between ESD and EMR. Conclusions: Considering that bleeding risk did not differ significantly between ESD and EMR and that perforation risk usually does not lead to life-threatening disease, the effectiveness benefit of ESD can outweigh the overall harm compared with EMR on the condition that ESD is performed by experienced practitioners.

AB - Background: Endoscopic submucosal dissection (ESD) allows en bloc resection of the entire lesion, permitting a higher curative resection rate and increased quality of life by minimizing the resection size compared with that of endoscopic mucosal resection (EMR). Although ESD has been implemented at most university hospitals in Korea, potential complications of ESD such as bleeding and perforation raise doubts in the therapeutic decision on use of the ESD procedure for early gastric cancer patients and in reimbursement decision making. This systematic review aimed to address both the effectiveness and safety outcomes of ESD versus EMR for early gastric cancer. Methods: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Koreamed were searched using the primary keywords "stomach neoplasm" AND "endoscopic submucosal dissection" AND "endoscopic mucosal resection." To assess the quality of selected studies, the methodologic approach of the Scottish Intercollegiate Guidelines Network was used. Five effectiveness-relevant and three safety-relevant outcome measures were extracted. Bibliography management and metaanalysis for each outcome were conducted using Review Manager 5.0. Results: Three nonconcurrent cohort studies and nine retrospective cohort studies were identified. Metaanalyses showed ESD to be significantly more effective than EMR for en bloc resection (odds ratio [OR], 8.43; 95% confidence interval [CI], 5.20-13.67), complete resection (OR, 14.11; 95% CI, 10.85-18.35), curative resection (OR, 3.28; 95% CI, 1.95-5.54), and local recurrence (risk ratio [RR], 0.13; 95% CI, 0.04-0.41). Whereas intraoperative bleeding (RR, 2.16; 95% CI, 1.14-4.09), perforation risk (RR, 3.58; 95% CI, 1.95-6.55), and operation time (standard mean difference [SMD], 1.55; 95% CI, 0.74-2.37) were significantly greater for ESD, overall bleeding risk (RR, 1.22; 95% CI, 0.76-1.98) and all-cause mortality (RR, 0.65; 95% CI, 0.08-5.38) did not differ significantly between ESD and EMR. Conclusions: Considering that bleeding risk did not differ significantly between ESD and EMR and that perforation risk usually does not lead to life-threatening disease, the effectiveness benefit of ESD can outweigh the overall harm compared with EMR on the condition that ESD is performed by experienced practitioners.

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VL - 25

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