MEDCIDS - Departamento de Medicina da Comunidade, Informação e Decisão em Saúde.
Gastroenterology Department, Instituto Português de Oncologia do Porto, Porto, Portugal.
Eur J Gastroenterol Hepatol. 2019 Oct;31(10):1234-1246. doi: 10.1097/MEG.0000000000001542.
Endoscopic submucosal dissection (ESD) is now established as the first option to manage early gastric neoplasms, but its efficacy may vary according to diverse factors. We aimed to systematically identify risk factors for poor short-term outcomes of gastric ESD with the purpose to improve patients' selection and management.
Three online databases (MEDLINE, ISI Web of Knowledge and Scopus) were searched (last search on June 2018) for poor outcomes of gastric ESD (deep submucosal invasion, piecemeal/incomplete resection, noncurative resection and local recurrence).
One hundred five studies were included referring to 52.126 ESDs. Undifferentiated histology and upper location (vs lower) were associated with submucosal invasion [odds ratio (OR) = 2.42 [95% confidence interval (CI), 1.62-3.61] and OR = 3.20 (1.04-9.86), respectively] and deep submucosal invasion [OR = 2.98 (2.02-4.39) and OR = 2.35 (1.45-3.81), respectively]. Lesion size greater than 30 mm and ulceration were associated with piecemeal resection [OR = 2.78 (1.17-6.60) and OR = 2.76 (1.23, 6.20), respectively]. Lesion size greater than 30 mm, ulceration, upper location and fibrosis were risk factors for incomplete resection [OR = 3.83 (2.68-5.49), OR = 4.06 (1.62-10.16), OR = 3.71 (2.49-5.54) and OR = 4.46 (1.66-11.96), respectively]. A noncurative resection was more often observed for lesions located in the upper third of the stomach [OR = 1.49 (1.24-1.79)], depressed morphology [OR = 1.49 (1.04-2.12)] and those outside standard criteria [OR = 3.56 (2.31-5.48)]. Older age was significantly linked with local recurrence rates [OR = 3.08 (1.13-5.02)].
Several risk factors influence poor efficacy short-term outcomes of gastric ESD that may be used to inform both patients and health providers about the expected efficacy.
内镜黏膜下剥离术（ESD）现已成为治疗早期胃癌的首选方法，但疗效可能因多种因素而异。我们旨在系统地确定影响胃 ESD 短期不良预后的危险因素，以便改善患者的选择和管理。
检索了三个在线数据库（MEDLINE、ISI Web of Knowledge 和 Scopus）（最后一次检索时间为 2018 年 6 月），以获取胃 ESD 的不良预后（黏膜下深层浸润、分片/不完全切除、非治愈性切除和局部复发）相关研究。
共纳入了 105 项研究，涉及 52126 例 ESD。未分化组织学和上部位置（与下部位置相比）与黏膜下浸润相关[比值比（OR）=2.42（95%置信区间（CI），1.62-3.61）和 OR=3.20（1.04-9.86）]和深层黏膜下浸润[OR=2.98（2.02-4.39）和 OR=2.35（1.45-3.81）]。病灶大小大于 30mm 和溃疡与分片切除相关[OR=2.78（1.17-6.60）和 OR=2.76（1.23-6.20）]。病灶大小大于 30mm、溃疡、上部位置和纤维化是不完全切除的危险因素[OR=3.83（2.68-5.49）、OR=4.06（1.62-10.16）、OR=3.71（2.49-5.54）和 OR=4.46（1.66-11.96）]。非治愈性切除更常见于胃上部[OR=1.49（1.24-1.79）]、凹陷型[OR=1.49（1.04-2.12）]和非标准标准病变[OR=3.56（2.31-5.48）]。年龄较大与局部复发率显著相关[OR=3.08（1.13-5.02）]。
一些危险因素会影响胃 ESD 的短期不良疗效，这可能有助于患者和医疗保健提供者了解预期的疗效。
