Peng Wei, Tan Shali, Ren Yutang, Li Huan, Peng Yan, Fu Xiangsheng, Tang Xiaowei
Department of Gastroenterology, the Affliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China.
Departmemt of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Beijing, China.
J Cardiothorac Surg. 2020 Feb 4;15(1):33. doi: 10.1186/s13019-020-1074-9.
Presently, endoscopic submucosal tunnel dissection (ESTD) has been a novel therapy for superficial esophageal neoplastic lesions (SENL), especially for circumferential neoplastic lesions. A number of studies have reported the clinical application of ESTD with promising outcomes. Therefore, we conducted a systematic review and meta-analysis to evaluated the efficacy and safety of ESTD for SENL .
From 2013 to November 2018, Pubmed, Embase and Cochrane databases were searched to determine studies reporting ESTD treatment of SENL. Weighted pooled rates (WPR) were calculated for en bloc resection, R0 resection and complication of ESTD. Risk ratios (RR) were calculated and pooled to compare the clinical outcomes of ESTD with ESD for SENL.
A total of 9 studies involving 494 patients with 518 esophageal neoplastic lesions were included in our study. WPR for en bloc resection and R0 resection of ESTD was 97.0% (95% CI: 94.7-98.3%) and 84.1% (95% CI: 80.5-87.1%), respectively. WPR for complication was 40.0% (95% CI: 25.8-56.1%). Two studies with 265 patients compared the performance of ESTD with ESD. Pooled RR for en bloc resection and R0 resection was 1.04 (95% CI: 0.95-1.14, P = 0.42) and 1.01 (95% CI: 0.93-1.10, P = 0.73), respectively. Pooled RR for complication was 0.68 (95% CI: 0.46-1.01, P = 0.05).
Our study showed that ESTD is effective for treating SENL with high en bloc resection rate and R0 resection rate, but accompanying by a relatively high complications.
目前，内镜黏膜下隧道剥离术（ESTD）已成为治疗浅表食管肿瘤性病变（SENL）的一种新疗法，尤其是对于环形肿瘤性病变。多项研究报道了ESTD的临床应用并取得了令人满意的结果。因此，我们进行了一项系统评价和荟萃分析，以评估ESTD治疗SENL的疗效和安全性。
检索2013年至2018年11月期间的Pubmed、Embase和Cochrane数据库，以确定报道ESTD治疗SENL的研究。计算ESTD整块切除、R0切除和并发症的加权合并率（WPR）。计算并汇总风险比（RR），以比较ESTD与ESD治疗SENL的临床结果。
我们的研究共纳入9项研究，涉及494例患者的518处食管肿瘤性病变。ESTD整块切除和R0切除的WPR分别为97.0%（95%CI：94.7-98.3%）和84.1%（95%CI：80.5-87.1%）。并发症的WPR为40.0%（95%CI：25.8-56.1%）。两项涉及265例患者的研究比较了ESTD与ESD的疗效。整块切除和R0切除的合并RR分别为1.04（95%CI：0.95-1.14，P = 0.42）和1.01（95%CI：0.93-1.10，P = 0.73）。并发症的合并RR为0.68（95%CI：0.46-1.01，P = 0.05）。
我们的研究表明，ESTD治疗SENL有效，整块切除率和R〇切除率高，但并发症相对较高。
