Bennett Cathy, Wang Yiping, Pan Tao
Cochrane UGPD Group, University of Leeds, Worsley Building Rm 8.49, University of Leeds, Leeds, West Yorkshire, UK, LS2 9JT.
Cochrane Database Syst Rev. 2009 Oct 7;2009(4):CD004276. doi: 10.1002/14651858.CD004276.pub3.
The treatment of early gastric cancer (EGC) using endoscopy, namely endoscopic mucosal resection (EMR), has been adopted for about 20 years, but the effectiveness and safety of the modality are still controversial. Furthermore, the risk of bias of trials of this technique has not been assessed systematically.
The purpose of this review was to compare the effectiveness and safety of endoscopic mucosal resection with gastrectomy for the treatment of early gastric cancer.
Searches were conducted on the Cochrane Central Register of Controlled Trials (CENTRAL) which includes the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group (UGPD) Trials Register (The Cochrane Library 2005, Issue 1), MEDLINE (1966 to March 2005), EMBASE (1980 to March 2005), CINAHL (1985 to March 2005) and CBM (Chinese BioMedical Database 1982 to 2002). The searches of CENTRAL, MEDLINE and EMBASE were updated in February 2006 and January 2009. Reference lists from trials selected by electronic searching were handsearched to identify further relevant trials. Published abstracts from conference proceedings from the United European Gastroenterology Week (published in Gut) and Digestive Disease Week (published in Gastroenterology) were handsearched. Members of the Cochrane UGPD Group, and experts in the field were contacted and asked to provide details of outstanding clinical trials and any relevant unpublished materials.
All randomised controlled trials of early gastric cancer patients involving a treatment arm of EMR and a comparison arm of gastrectomy were to be included, but no RCTs were found.
Three review authors (YP Wang, C Bennett and T Pan) independently assessed the eligibility of potential trials and extracted the data.
There were no randomised controlled trials identified for systematic review. Available evidence derived from non-randomised controlled trials is discussed in the main text of this review.
AUTHORS' CONCLUSIONS: There is a lack of randomised controlled trials in which endoscopic mucosal resection (EMR) is compared with gastrectomy for early gastric cancer. There is, therefore, a need for well-designed randomised controlled trials to determine the effects of EMR compared to gastrectomy.
使用内镜治疗早期胃癌（EGC），即内镜黏膜切除术（EMR），已应用约20年，但该方法的有效性和安全性仍存在争议。此外，尚未系统评估该技术试验的偏倚风险。
本综述的目的是比较内镜黏膜切除术与胃切除术治疗早期胃癌的有效性和安全性。
检索了Cochrane对照试验中心注册库（CENTRAL），其中包括Cochrane上消化道和胰腺疾病组（UGPD）试验注册库（《Cochrane图书馆》2005年第1期）、MEDLINE（1966年至2005年3月）、EMBASE（1980年至2005年3月）、CINAHL（1985年至2005年3月）和中国生物医学文献数据库（CBM，1982年至2002年）。CENTRAL、MEDLINE和EMBASE的检索在2006年2月和2009年1月进行了更新。对通过电子检索选择的试验的参考文献列表进行了手工检索，以识别更多相关试验。对欧洲胃肠病学联合周（发表于《肠道》）和消化疾病周（发表于《胃肠病学》）会议论文集的已发表摘要进行了手工检索。联系了Cochrane UGPD组的成员和该领域的专家，并要求他们提供未发表的优秀临床试验和任何相关未发表材料的详细信息。
纳入所有涉及早期胃癌患者且有内镜黏膜切除术治疗组和胃切除术对照组的随机对照试验，但未找到随机对照试验。
三位综述作者（王YP、C·贝内特和潘T）独立评估潜在试验的合格性并提取数据。
未识别出可进行系统综述的随机对照试验。本综述正文讨论了来自非随机对照试验的现有证据。
缺乏将内镜黏膜切除术（EMR）与胃切除术用于早期胃癌比较的随机对照试验。因此，需要设计良好的随机对照试验来确定与胃切除术相比内镜黏膜切除术的效果。
