Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome.
Gastroenterology and Digestive Endoscopy, 'Generale' Hospital', Perugia.
Eur J Gastroenterol Hepatol. 2021 Nov 1;33(11):e1-e6. doi: 10.1097/MEG.0000000000001886.
Endoscopic submucosal dissection (ESD) for gastric neoplastic lesions removal is largely performed in Asian countries. Unfortunately, ESD diffusion, particularly for gastric lesion removal, is still limited in Western countries. We performed a systematic review of available data coming from Western centers. The en bloc and the R0 resection rates for all neoplastic lesions, including early gastric cancer (EGC) and dysplasia, were calculated, as well as the curative rate for EGC. Complications and the 1-month mortality rates were computed. A total of 22 studies from Europe (N = 15), Latina America (N = 6), and Canada (N = 1) were retrieved, with 1152 patients and 1210 lesions. The en bloc resection was successful in 96% [95% confidence interval (CI) 93-98] with a significant heterogeneity (I2 = 63.5%; P < 0.0001). The R0 was achieved in 84% (95% CI 79-89; I2 = 79.9%; P < 0.001). The resection rate was curative in 72% out of 340 patients with EGC (95% CI 65-79, I2 = 8%; P = 0.36). Overall, complications occurred in 9.5% of patients, including bleeding (5.8%), perforation (3.4%), and stenosis (0.35%). A total of three (0.26%) patients deceased within 1 month, but none was directly related to the procedure. Lesion recurrence was observed in 38 (3.5%; 95% CI 2.3-4.4) cases, including 21 EGC and 17 dysplasia. In Western countries, the en bloc and the R0 resections were successful in the large majority of cases, whilst the resection was curative in 72% of patients with EGC. The complications rate was acceptably low.
内镜黏膜下剥离术（ESD）广泛应用于亚洲国家的胃肿瘤性病变切除。不幸的是，ESD 的应用，特别是胃病变切除，在西方国家仍受到限制。我们对来自西方中心的现有数据进行了系统回顾。计算了所有肿瘤性病变（包括早期胃癌（EGC）和异型增生）的整块和 R0 切除率，以及 EGC 的治愈率。计算了并发症和 1 个月死亡率。共检索到来自欧洲（N = 15）、拉丁美洲（N = 6）和加拿大（N = 1）的 22 项研究，共 1152 例患者和 1210 例病变。整块切除成功率为 96%（95%CI 93-98），存在显著异质性（I2 = 63.5%；P < 0.0001）。R0 切除率为 84%（95%CI 79-89；I2 = 79.9%；P < 0.001）。340 例 EGC 患者中，有 72%（95%CI 65-79，I2 = 8%；P = 0.36）的患者切除达到治愈效果。总体而言，9.5%的患者发生了并发症，包括出血（5.8%）、穿孔（3.4%）和狭窄（0.35%）。共有 3 例（0.26%）患者在 1 个月内死亡，但均与手术无关。38 例（3.5%；95%CI 2.3-4.4）患者出现病变复发，包括 21 例 EGC 和 17 例异型增生。在西方国家，绝大多数情况下整块和 R0 切除是成功的，而 EGC 患者中有 72%的切除是治愈性的。并发症发生率较低。
