Benites-Goñi Harold, Palacios-Salas Fernando, Marín-Calderón Luis, Diaz-Arocutipa Carlos, Piscoya Alejandro, Hernandez Adrian V
Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET), Universidad San Ignacio de Loyola (USIL), Peru (Harold Benites-Goñi, Carlos Diaz-Arocutipa, Adrian V. Hernandez).
Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru (Harold Benites-Goñi, Luis Marín-Calderón).
Ann Gastroenterol. 2023 Mar-Apr;36(2):167-177. doi: 10.20524/aog.2023.0777. Epub 2023 Jan 30.
Endoscopic submucosal dissection (ESD) is now considered the standard treatment for early gastric cancer (EGC). However, the widespread adoption of ESD in western countries has been slow. We performed a systematic review to evaluate short-term outcomes of ESD for EGC in non-Asian countries.
We searched 3 electronic databases from inception until October 26, 2022. Primary outcomes were , R0 and curative resections rate by region. Secondary outcomes were overall complications, bleeding, and perforation rate by region. The proportion of each outcome, with the 95% confidence interval (CI), was pooled using a random-effects model with the Freeman-Tukey double arcsine transformation.
Twenty-seven studies from Europe (n=14), South America (n=11) and North America (n=2) were included, involving 1875 gastric lesions. Overall, , R0, and curative resection rates were achieved in 96% (95%CI 94-98%), 85% (95%CI 81-89%), and 77% (95%CI 73-81%) of cases, respectively. Considering only information from lesions with adenocarcinoma, the overall curative resection was 75% (95CI 70-80%). Bleeding and perforation were observed in 5% (95%CI 4-7%) and 2% (95%CI 1-4%) of cases, respectively.
Our results suggest that short-term outcomes of ESD for the treatment of EGC are acceptable in non-Asian countries.
内镜黏膜下剥离术（ESD）目前被认为是早期胃癌（EGC）的标准治疗方法。然而，ESD在西方国家的广泛应用进展缓慢。我们进行了一项系统评价，以评估非亚洲国家ESD治疗EGC的短期疗效。
我们检索了3个电子数据库，检索时间从建库至2022年10月26日。主要结局指标为按地区划分的整块切除率、R0切除率和根治性切除率。次要结局指标为按地区划分的总体并发症、出血和穿孔率。使用Freeman-Tukey双反正弦变换的随机效应模型汇总每个结局指标的比例及其95%置信区间（CI）。
纳入了来自欧洲（n=14）、南美洲（n=11）和北美洲（n=2）的27项研究，涉及1875个胃部病变。总体而言，整块切除率、R0切除率和根治性切除率分别在96%（95%CI 94-98%）、85%（95%CI 81-89%）和77%（95%CI 73-81%）的病例中实现。仅考虑腺癌病变的信息，总体根治性切除率为75%（95%CI 70-80%）。分别有5%（95%CI 4-7%）和2%（95%CI 1-4%）的病例发生出血和穿孔。
我们的结果表明，在非亚洲国家，ESD治疗EGC的短期疗效是可以接受的。
