Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA.
Department of Biostatistics, University of Florida, Gainesville, Florida, USA.
Gastrointest Endosc. 2018 Jun;87(6):1383-1393. doi: 10.1016/j.gie.2017.09.038. Epub 2017 Oct 6.
The role of endoscopic submucosal dissection (ESD) in Barrett's esophagus (BE) is not well established. This meta-analysis aimed to evaluate the safety and efficacy of ESD for the management of early BE neoplasia.
Three online databases were searched. The Cochran Q test and I were used to test for heterogeneity. Pooling was conducted using either fixed- or random-effects models depending on heterogeneity across studies. For the main outcomes, potential sources of heterogeneity were evaluated via linear regression analysis.
Eleven studies (501 patients, 524 lesions) were included. Mean lesion size was 27 mm (95% confidence interval [CI], 20.9-33.1). Pooled estimate for en bloc resection was 92.9% (95% CI, 90.3%-95.2%). The pooled R0 (complete) and curative resection rates were 74.5% (95% CI, 66.3%-81.9%) and 64.9% (95% CI, 55.7%-73.6%), respectively. There was no association between R0 or curative resection rates and study setting (Asia vs West), length of BE, lesion characteristics, procedural time, or length of follow-up. The pooled estimates for perforation and bleeding were 1.5% (95% CI, .4%-3.0%) and 1.7% (95% CI, .6%-3.4%), respectively. Esophageal stricture rate was 11.6% (95% CI, .9%-29.6%). Incidence of recurrence after curative resection was .17% (95% CI, 0%-.3%) at a mean follow-up 22.9 months (95% CI, 17.5-28.3).
ESD for early BE neoplasia is associated with a high en bloc resection rate, acceptable safety profile, and low recurrence after curative resection. ESD should be considered as part of the armamentarium for the management of BE neoplasia.
内镜黏膜下剥离术（ESD）在 Barrett 食管（BE）中的作用尚未得到充分确立。本荟萃分析旨在评估 ESD 治疗早期 BE 肿瘤的安全性和有效性。
检索了 3 个在线数据库。使用 Cochran Q 检验和 I ² 检验评估异质性。根据研究间的异质性，采用固定效应模型或随机效应模型进行合并。对于主要结局，通过线性回归分析评估潜在的异质性来源。
纳入了 11 项研究（501 例患者，524 处病变）。平均病变大小为 27mm（95%置信区间 [CI]，20.9-33.1）。整块切除的汇总估计值为 92.9%（95% CI，90.3%-95.2%）。汇总的 R0（完全）和根治性切除率分别为 74.5%（95% CI，66.3%-81.9%）和 64.9%（95% CI，55.7%-73.6%）。R0 或根治性切除率与研究地点（亚洲与西方）、BE 长度、病变特征、手术时间或随访时间之间无关联。穿孔和出血的汇总估计值分别为 1.5%（95% CI，.4%-3.0%）和 1.7%（95% CI，.6%-3.4%）。食管狭窄发生率为 11.6%（95% CI，.9%-29.6%）。根治性切除后复发的发生率为.17%（95% CI，0%-.3%），平均随访 22.9 个月（95% CI，17.5-28.3）。
ESD 治疗早期 BE 肿瘤具有较高的整块切除率、可接受的安全性和根治性切除后的低复发率。ESD 应被视为 BE 肿瘤治疗的手段之一。
