Division of Gastroenterology and Hepatology, Johns Hopkins University, 733 N Broadway, Baltimore, MD, USA.
Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Surg Endosc. 2022 Mar;36(3):1775-1788. doi: 10.1007/s00464-021-08452-8. Epub 2021 Apr 6.
Conventional endoscopic submucosal dissection (C-ESD) is a technically demanding procedure with prolonged procedure times and higher risk of adverse events. To overcome the procedural difficulty of ESD, several traction-assisted techniques (T-ESD) have been developed to improve visualization of the submucosa in hopes to facilitate safe and effective dissection. The aim of this study was to conduct a meta-analysis that compares short-term outcomes (30-day) of T-ESD to C-ESD.
Clinical studies published up to April 2020 comparing the efficacy and safety of T-ESD and C-ESD were identified using electronic bibliographic searches. Both randomized controlled trials and observational studies were included. Outcomes of interests were procedure time, rates of en bloc and R0 resection, and rates of adverse events. Fixed effect and random effect model were used to calculate pooled mean difference for continuous variables and risk differences (RDs) for categorical variables.
Twenty-three studies with 2574 patients were included in this meta-analysis, with a total of 2582 lesions (1292 T-ESD and 1290 C-ESD). Pooled estimates of T-ESD showed shorter procedure times (weighted mean difference = -20.35 min, 95% CI -27.51 to -13.19, p < 0.001), higher R0 resection rates (RD 0.04, 95% CI 0.01-0.06, p = 0.004) and lower perforation rates (RD -0.03, 95% CI -0.04 to -0.01, p = < 0.0001). No significant differences were seen in en bloc rates and bleeding risk between the two groups.
Traction-assisted ESD results in shorter procedure time, improved R0 resection rates and lower risk of perforation as compared to conventional ESD.
传统内镜黏膜下剥离术(C-ESD)技术要求高,手术时间长,不良事件风险高。为了克服 ESD 的手术难度,已经开发了几种牵引辅助技术(T-ESD),以改善黏膜下的可视化,从而促进安全有效的剥离。本研究旨在进行一项荟萃分析,比较 T-ESD 与 C-ESD 的短期(30 天)结果。
使用电子文献检索,检索截至 2020 年 4 月比较 T-ESD 和 C-ESD 疗效和安全性的临床研究。纳入随机对照试验和观察性研究。感兴趣的结局包括手术时间、整块切除率和 R0 切除率以及不良事件发生率。使用固定效应和随机效应模型计算连续变量的汇总均数差和分类变量的风险差(RD)。
本荟萃分析纳入了 23 项研究,共 2574 例患者,共 2582 处病变(T-ESD 组 1292 例,C-ESD 组 1290 例)。T-ESD 组的汇总估计显示手术时间更短(加权均数差=-20.35 分钟,95%CI-27.51 至-13.19,p<0.001),R0 切除率更高(RD0.04,95%CI0.01-0.06,p=0.004),穿孔率更低(RD-0.03,95%CI-0.04 至-0.01,p<0.0001)。两组的整块切除率和出血风险无显著差异。
与传统 ESD 相比,牵引辅助 ESD 可缩短手术时间,提高 R0 切除率,降低穿孔风险。