Lorenzo Fuccio1, Cesare Hassan2, Thierry Ponchon3, Daniele Mandolesi1, Andrea Farioli1, Alessandro Cucchetti1, Leonardo Frazzoni1, Pradeep Bhandari4, Cristina Bellisario5, Franco Bazzoli1, Alessandro Repici6. 1. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 2. Nuovo Regina Margherita Hospital, Rome, Italy. 3. Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon, France. 4. Queen Alexandra Hospital, Cosham, Portsmouth, United Kingdom. 5. Department of Cancer Screening, Centre for Epidemiology and Prevention in Oncology (CPO), University Hospital Città della Salute e della Scienza di Torino, Turin, Italy. 6. Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano (MI), Italy.
Abstract
BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) is an endoscopic resection technique for lesions suspicious of superficial malignancy. It is performed using an ESD knife on its own (standard technique) or by the sequential use of a knife and a snare (hybrid technique). The experience with these techniques is different in Asian and non-Asian countries. We performed a systematic review and meta-analysis of available evidence on colorectal ESD. METHODS: Electronic databases were searched up to August 2016 for studies evaluating R0, en bloc resection, and adverse event rates of both techniques for the treatment of colorectal lesions. Proportions were pooled by a random effects model. RESULTS: Ninety-seven studies (71 performed in Asia) evaluated the standard technique and 12 studies (7 in Asia) the hybrid technique. The R0 resection rate of the standard technique was 82.9%, and it was significantly lower in non-Asian versus Asian countries: 71.3% versus 85.6%. The en bloc resection rate was 91% and was significantly lower in non-Asian versus Asian countries (81.2% vs 93%, respectively). Surgery was needed in 1.1% of the ESD-related adverse events, with a significant difference between non-Asian and Asian countries (3.1% vs 0.8%). The R0 and en bloc resection rates with the hybrid technique were significantly lower than those achieved with the standard technique: 60.6% and 68.4%, respectively, with similar adverse event rates. CONCLUSIONS: In non-Asian countries the standard ESD technique is still failing to achieve acceptable levels of performance. The hybrid technique showed low R0 resection rates and should not be considered as an adequate alternative to the standard technique.
BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) is an endoscopic resection technique for lesions suspicious of superficial malignancy. It is performed using an ESD knife on its own (standard technique) or by the sequential use of a knife and a snare (hybrid technique). The experience with these techniques is different in Asian and non-Asian countries. We performed a systematic review and meta-analysis of available evidence on colorectal ESD. METHODS: Electronic databases were searched up to August 2016 for studies evaluating R0, en bloc resection, and adverse event rates of both techniques for the treatment of colorectal lesions. Proportions were pooled by a random effects model. RESULTS: Ninety-seven studies (71 performed in Asia) evaluated the standard technique and 12 studies (7 in Asia) the hybrid technique. The R0 resection rate of the standard technique was 82.9%, and it was significantly lower in non-Asian versus Asian countries: 71.3% versus 85.6%. The en bloc resection rate was 91% and was significantly lower in non-Asian versus Asian countries (81.2% vs 93%, respectively). Surgery was needed in 1.1% of the ESD-related adverse events, with a significant difference between non-Asian and Asian countries (3.1% vs 0.8%). The R0 and en bloc resection rates with the hybrid technique were significantly lower than those achieved with the standard technique: 60.6% and 68.4%, respectively, with similar adverse event rates. CONCLUSIONS: In non-Asian countries the standard ESD technique is still failing to achieve acceptable levels of performance. The hybrid technique showed low R0 resection rates and should not be considered as an adequate alternative to the standard technique.
Authors: Anne F Peery; Nicholas J Shaheen; Katherine S Cools; Todd H Baron; Mark Koruda; Joseph A Galanko; Ian S Grimm Journal: Gastrointest Endosc Date: 2017-04-10 Impact factor: 9.427
Authors: Neal Mehta; Ashraf Abushahin; Meena Sadaps; Mohammad Alomari; John Vargo; Deepa Patil; Rocio Lopez; Matthew Kalady; Conor P Delaney; Emre Gorgun; James Church; Yutaka Saito; Carol A Burke; Amit Bhatt Journal: Surg Endosc Date: 2020-05-29 Impact factor: 4.584