水下内镜黏膜切除术与传统内镜黏膜切除术治疗直径≤20mm的浅表非壶腹十二指肠上皮肿瘤的系统评价及Meta分析

Underwater Endoscopic Mucosal Resection Versus Conventional Endoscopic Mucosal Resection for Superficial Non-ampullary Duodenal Epithelial Tumors ≤20 mm: A Systematic Review With Meta-analysis.

作者信息

Yin Zhikun, Li Ji, Yang Weilin, Huang Weifeng, Xu Dong, Lei Xiaoyi, Zhang Jinyan

机构信息

The Third Clinical Medical College, Fujian Medical University, Fuzhou, Fujian.

Department of Gastroenterology.

出版信息

J Clin Gastroenterol. 2023 Oct 1;57(9):928-936. doi: 10.1097/MCG.0000000000001763.

DOI:10.1097/MCG.0000000000001763

PMID:36084162

Abstract

BACKGROUND

Underwater endoscopic mucosal resection (UEMR) is increasingly applied in the treatment of superficial non-ampullary duodenal epithelial tumors (SNADETs). This meta-analysis aimed to assess the efficacy and safety of UEMR for SNADETs ≤20 mm in comparison with conventional endoscopic mucosal resection (CEMR).

METHODS

The following electronic databases were searched from 2012 until November 20, 2021: PubMed, Embase, Scopus, Web of Science databases, and Cochrane Library. The primary outcomes were the rates of en bloc resection and complete (R0) resection, and the secondary outcomes were procedure time, adverse events (delayed bleeding and delayed perforation), and recurrence rate.

RESULTS

A total of 6 studies with 679 lesions (331 underwent UEMR and 348 CEMR) were included in this study. The pooled analysis showed that UMER achieves a similar en bloc resection rate (87.6 vs. 89.9%; odds ratio [OR], 1.29; 95% confidence interval [CI], 0.45 to 3.73; P =0.64; I2 =74%), a similar R0 resection rate (67.3 vs. 73.6%; OR, 1.11; 95% CI, 0.55 to 2.23; P =0.78; I2 =59%), a shorter procedure time (min) (mean difference [MD], -4.05, 95% CI: -6.40 to -1.71; P =0.0007; I2 =70%) compared with CEMR. There were no significant differences in the rates of delayed bleeding, delayed perforation, and recurrence (2.4 vs. 1.7%, 0 vs. 0.6%, 2.2 vs. 4.4%, respectively).

CONCLUSION

This meta-analysis demonstrated that UEMR appears to be an effective and safe alternative to CEMR for SNADETs ≤20 mm.

摘要

背景

水下内镜黏膜切除术（UEMR）在浅表非壶腹十二指肠上皮肿瘤（SNADETs）的治疗中应用越来越广泛。本荟萃分析旨在评估UEMR治疗直径≤20mm的SNADETs与传统内镜黏膜切除术（CEMR）相比的疗效和安全性。

方法

检索2012年至2021年11月20日的以下电子数据库：PubMed、Embase、Scopus、Web of Science数据库和Cochrane图书馆。主要结局是整块切除率和完整（R0）切除率，次要结局是手术时间、不良事件（延迟出血和延迟穿孔）和复发率。

结果

本研究共纳入6项研究，涉及679个病变（331例行UEMR，348例行CEMR）。汇总分析显示，与CEMR相比，UEMR的整块切除率相似（87.6%对89.9%；优势比[OR]，1.29；95%置信区间[CI]，0.45至3.73；P =0.64；I2 =74%），R0切除率相似（67.3%对73.6%；OR，1.11；95%CI，0.55至2.23；P =0.78；I2 =59%），手术时间更短（分钟）（平均差[MD]，-4.05，95%CI：-6.40至-1.71；P =0.0007；I2 =70%）。延迟出血、延迟穿孔和复发率无显著差异（分别为2.4%对1.7%，0对0.6%，2.2%对4.4%）。