内镜黏膜下剥离术与手术或内镜黏膜切除术治疗胃早期多发癌的比较：一项荟萃分析。

Endoscopic Submucosal Dissection Versus Surgery or Endoscopic Mucosal Resection for Metachronous Early Gastric Cancer: a Meta-analysis.

机构信息

Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, CWPH 6D19, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.

Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.

出版信息

J Gastrointest Surg. 2023 Nov;27(11):2628-2639. doi: 10.1007/s11605-023-05840-4. Epub 2023 Sep 26.

DOI:10.1007/s11605-023-05840-4

PMID:37752384

Abstract

BACKGROUND

Resection options for early gastric cancer (EGC) include endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and surgery. In patients with metachronous EGC following previous resection, the optimal resection technique is not well elucidated. We conducted a systematic review and meta-analysis of studies comparing ESD to EMR, or ESD to surgery, in patients with metachronous EGC.

METHODS

We conducted an electronic search of studies reporting on outcomes and AEs following ESD versus either EMR or surgery for patients with metachronous EGC. Pooled odds ratios (OR) of included studies were obtained using DerSimonian and Laird random effects models. Funnel plots were produced and visually inspected for evidence of publication bias. The quality of the evidence was assessed using GRADE.

RESULTS

A total of 9367 abstracts were screened and 10 observational studies were included. The odds of complete resection were higher amongst patients undergoing ESD compared to EMR (OR 5.88, 95% confidence intervals, CI, 1.79-19.35), whereas the odds of complete resection were no different between ESD and surgery (OR 0.57, 95% CI 0.04-8.24). There were no differences in the odds of local recurrence with ESD versus surgery (OR 5.01, 95% CI 0.86-29.13). Post-procedural bleeding did not differ significantly between ESD and EMR (OR 0.70, 95% CI 0.16-3.00). There was no evidence of publication bias.

DISCUSSION

For metachronous EGC, ESD or surgery is preferred over EMR depending on local expertise and patient preferences, largely due to a higher risk of incomplete resection with EMR.

REVIEW REGISTRATION

PROSPERO CRD42021270445.

摘要

背景

早期胃癌（EGC）的切除选择包括内镜黏膜下剥离术（ESD）、内镜黏膜切除术（EMR）和手术。对于先前切除后出现的异时性 EGC 患者，最佳切除技术尚未阐明。我们对比较 ESD 与 EMR 或 ESD 与手术治疗异时性 EGC 患者的研究进行了系统回顾和荟萃分析。

方法

我们对报告 ESD 与 EMR 或 ESD 与手术治疗异时性 EGC 患者结局和不良反应的研究进行了电子检索。使用 DerSimonian 和 Laird 随机效应模型获得纳入研究的汇总优势比（OR）。绘制漏斗图并进行视觉检查，以评估发表偏倚的证据。使用 GRADE 评估证据质量。

结果

共筛选了 9367 篇摘要，纳入了 10 项观察性研究。与 EMR 相比，接受 ESD 的患者完全切除的可能性更高（OR 5.88，95%置信区间，CI，1.79-19.35），而 ESD 与手术完全切除的可能性无差异（OR 0.57，95%CI 0.04-8.24）。ESD 与手术相比，局部复发的可能性没有差异（OR 5.01，95%CI 0.86-29.13）。ESD 与 EMR 相比，术后出血无显著差异（OR 0.70，95%CI 0.16-3.00）。没有发现发表偏倚的证据。