Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
Department of Endoscopic Diagnosis and Treatment, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
Gastrointest Endosc. 2021 May;93(5):1038-1046.e4. doi: 10.1016/j.gie.2021.01.007. Epub 2021 Jan 21.
The pocket-creation method (PCM) is a newly developed strategy for colorectal endoscopic submucosal dissection (ESD). However, its superiority over the conventional method (CM) has not been established. The aim of this meta-analysis was to evaluate the efficacy and safety of PCM-ESD compared with CM-ESD for superficial colorectal neoplasms (SCNs).
Literature searches were conducted using the Pubmed, Embase, and Cochrane Library databases, and a meta-analysis was performed. The primary outcome was the R0 resection rate, and the secondary outcomes were the en bloc resection rate, dissection speed, procedure time, and adverse event rate.
Five studies (2 randomized controlled trials and 3 retrospective studies) with 1481 patients were included in our meta-analysis. The pooled analysis showed that PCM-ESD achieved a higher R0 resection rate (93.5% vs 78.1%; odds ratio [OR], 3.4; 95% confidence interval [CI], 1.3-8.9; I = 58%), a higher en bloc resection rate (99.8% vs 92.8%; OR, 9.9; 95% CI, 2.7-36.2; I = 0), a shorter procedure time (minutes) (mean difference [MD], -11.5; 95% CI, -19.9 to -3.1; I = 72%), a faster dissection speed (mm/min) (MD, 3.6; 95% CI, 2.8-4.5; I = 0), and a lower overall adverse event rate (4.4% vs 6.6%; OR, 0.6; 95% CI, 0.3-1.0; I = 0) compared with CM-ESD.
This meta-analysis showed that PCM-ESD improves the efficacy and safety compared with CM-ESD for superficial colorectal neoplasms.
口袋创造法（PCM）是一种新开发的用于结直肠内镜黏膜下剥离术（ESD）的策略。然而，其与传统方法（CM）相比的优越性尚未得到证实。本荟萃分析的目的是评估 PCM-ESD 与 CM-ESD 治疗浅表性结直肠肿瘤（SCN）的疗效和安全性。
使用 Pubmed、Embase 和 Cochrane 图书馆数据库进行文献检索，并进行荟萃分析。主要结局是 R0 切除率，次要结局是整块切除率、剥离速度、手术时间和不良事件发生率。
共有 5 项研究（2 项随机对照试验和 3 项回顾性研究）纳入了 1481 例患者。汇总分析显示，PCM-ESD 实现了更高的 R0 切除率（93.5%比 78.1%；优势比[OR]，3.4；95%置信区间[CI]，1.3-8.9；I=58%）、更高的整块切除率（99.8%比 92.8%；OR，9.9；95%CI，2.7-36.2；I=0）、更短的手术时间（分钟）（平均差[MD]，-11.5；95%CI，-19.9 至-3.1；I=72%）、更快的剥离速度（mm/min）（MD，3.6；95%CI，2.8-4.5；I=0）和更低的总体不良事件发生率（4.4%比 6.6%；OR，0.6；95%CI，0.3-1.0；I=0）与 CM-ESD 相比。
本荟萃分析表明，与 CM-ESD 相比，PCM-ESD 可提高治疗浅表性结直肠肿瘤的疗效和安全性。
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