Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy.
Endoscopy. 2012 Feb;44(2):137-50. doi: 10.1055/s-0031-1291448. Epub 2012 Jan 23.
Endoscopic submucosal dissection (ESD) has been proposed for large colorectal lesions, due to the high risk of recurrence following endoscopic mucosal resection. However, data on the efficacy and safety of colorectal ESD are still controversial. The aim of the current systematic review was to assess the efficacy and safety of colorectal ESD.
A detailed Medline search of papers published during the period 1999-2010 was performed, using the search terms "Endoscopic submucosal dissection," "Colorectal neoplasia," "Colon," or "Rectum." Published studies that evaluated ESD for colorectal lesions were assessed using well-defined inclusion/exclusion criteria, including histological confirmation and surgery for complications. The process was independently performed by two authors. Forest plots on primary (i.e. histologically verified R0 resection and surgery for ESD complications) and secondary end-points were produced based on random-effect models. Heterogeneity was assessed using the I2 statistic. Risk for within-study bias was also ascertained.
A total of 22 studies (20 Asian, two European) provided data on 2841 ESD-treated lesions. The per-lesion summary estimate of R0 resection rate was 88% (95%CI 82%-92%; I2=91%). At meta-regression, carcinoid vs. non-carcinoid series (R0 93% vs. 87%; P=0.04) and Asian vs. European series (R0 88% vs. 65%; P=0.03) appeared to explain the detected heterogeneity. The per-lesion summary estimate of surgery for ESD complications was 1% (95%CI 0%-1%) with a moderate degree of heterogeneity (I2=49%). However, subgrouping of these results according to histological tumor types was not available in the reviewed studies.
ESD appeared to be an extremely effective technique to achieve R0 resection of large colorectal lesions. The very low rate of surgery for complications also shows the potential safety of this approach.
内镜黏膜下剥离术（ESD）已被提议用于治疗大肠的大型病变，因为内镜下黏膜切除术（EMR）后有较高的复发风险。然而，关于大肠 ESD 的疗效和安全性的数据仍然存在争议。本系统综述的目的是评估大肠 ESD 的疗效和安全性。
使用“Endoscopic submucosal dissection”、“Colorectal neoplasia”、“Colon”或“Rectum”等搜索词，对 1999 年至 2010 年期间发表的论文进行了详细的 Medline 搜索。评估了使用明确的纳入/排除标准评估大肠病变的 ESD 治疗，包括组织学确认和并发症手术。该过程由两名作者独立进行。基于随机效应模型生成了主要（即组织学证实的 R0 切除和 ESD 并发症手术）和次要终点的森林图。使用 I2 统计量评估异质性。还确定了研究内偏倚的风险。
共有 22 项研究（20 项亚洲研究，2 项欧洲研究）提供了 2841 例 ESD 治疗病变的数据。R0 切除率的每病变汇总估计值为 88%（95%CI 82%-92%；I2=91%）。在元回归中，类癌与非类癌系列（R0 93%与 87%；P=0.04）和亚洲与欧洲系列（R0 88%与 65%；P=0.03）似乎解释了检测到的异质性。ESD 并发症手术的每病变汇总估计值为 1%（95%CI 0%-1%），异质性程度中等（I2=49%）。然而，在审查的研究中，没有根据组织学肿瘤类型对这些结果进行分组。
ESD 似乎是一种非常有效的技术，可以实现大肠大型病变的 R0 切除。并发症手术的极低发生率也表明了这种方法的潜在安全性。
