Division of Gastroenterology, The Brooklyn Hospital Center, 121 De Kalb Ave, Brooklyn, NY, 11201, USA.
MD Anderson Cancer Center, Houston, TX, USA.
Surg Endosc. 2019 Aug;33(8):2381-2395. doi: 10.1007/s00464-019-06778-y. Epub 2019 Apr 8.
Endoscopic submucosal dissection (ESD) for early gastric cancer is highly effective and well established. Performing ESD in the surgically altered stomach (SAS) is challenging. The aim of this meta-analysis is to assess the safety and efficacy of ESD for patients with early neoplastic lesions occurring in the SAS with a subgroup analysis of lesions occurring on the suture line compared to non-suture line lesions and outcomes in the remnant stomach compared to the gastric tube.
We performed a literature search of the PubMed, Embase, and CINAHL electronic databases from January 2000 to November 2017 for articles reporting the safety and efficacy of ESD in the surgically altered stomach. SAS was defined as the remnant stomach following gastrectomy and gastric tube following esophagectomy. Meta-analysis was performed using Review Manager version 5.3 software.
A total of 21 articles, with 903 lesions occurring in the remnant stomach or gastric tube, were included in this study. There was no significant difference between en bloc (RR 0.99, 95% CI 0.91-1.08), curative resection (RR 1.03, 95% CI 0.84-1.26), or bleeding rates (RR 1.40, 95% CI 0.18-10.72) between lesions in the remnant stomach and gastric tube. However, perforation was significantly higher in the gastric tube (RR 5.19, 95% 1.27-21.25). Suture line lesions had a significantly higher risk of perforation (RR 4.55, 95% CI 2.13-9.74).
ESD for early neoplastic lesions occurring in the SAS is a safe and efficacious with similar en bloc and curative resection rates compared to the anatomically normal stomach. ESD for lesions on the suture line or in the gastric tube is associated with an increased risk of perforation which can be managed endoscopically.
内镜黏膜下剥离术（ESD）治疗早期胃癌效果显著且已广泛应用。然而，在外科改变后的胃（SAS）中进行 ESD 具有挑战性。本荟萃分析旨在评估 ESD 治疗 SAS 中早期肿瘤性病变的安全性和有效性，并对缝线部位与非缝线部位病变以及残胃与胃管之间的结果进行亚组分析。
我们对 2000 年 1 月至 2017 年 11 月期间 PubMed、Embase 和 CINAHL 电子数据库中的文献进行了检索，以查找报道 ESD 在外科改变后的胃中安全性和有效性的文章。SAS 定义为胃切除术后的残胃和食管切除术后的胃管。使用 Review Manager 版本 5.3 软件进行荟萃分析。
共有 21 篇文章，903 处病变发生在残胃或胃管中，纳入本研究。残胃和胃管中的病变在整块切除（RR 0.99，95%CI 0.91-1.08）、治愈性切除（RR 1.03，95%CI 0.84-1.26）或出血率（RR 1.40，95%CI 0.18-10.72）方面无显著差异。然而，胃管穿孔率明显更高（RR 5.19，95%CI 1.27-21.25）。缝线部位病变穿孔风险显著升高（RR 4.55，95%CI 2.13-9.74）。
SAS 中早期肿瘤性病变的 ESD 是一种安全有效的治疗方法，与解剖正常胃相比，整块切除和治愈性切除率相似。缝线部位或胃管中的病变与穿孔风险增加相关，但可通过内镜进行处理。
