Comparison of EMR versus endoscopic submucosal dissection for Barrett's neoplasia and esophageal adenocarcinoma: a systematic review and meta-analysis.

Autor: Fujiyoshi Y; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: yusukefujiyoshi@yahoo.co.jp., Khalaf K; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., He T; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia., Tham D; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Yuan Y; Department of Medicine, London Health Science Centre, London, Ontario, Canada; Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada., Calo NC; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Grover SC; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Teshima CW; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Jazyk: angličtina
Zdroj: Gastrointestinal endoscopy [Gastrointest Endosc] 2024 Nov; Vol. 100 (5), pp. 817-828.e5. Date of Electronic Publication: 2024 Jun 13.
DOI: 10.1016/j.gie.2024.06.012
Abstrakt: Background and Aims: EMR and endoscopic submucosal dissection (ESD) are both accepted resection strategies for Barrett's esophagus-related neoplasia and esophageal adenocarcinoma (EAC). However, a lack of consensus exists regarding which technique offers superior outcomes. This study aims to systematically review the evidence comparing EMR versus ESD in treating Barrett's neoplasia and EAC.
Methods: We searched 3 databases (Embase, MEDLINE, Cochrane Central) through October 2023. We included studies comparing the efficacy of EMR and ESD for Barrett's neoplasia and EAC. Primary outcomes include en bloc, R0, and curative resection; complete remission of dysplasia (CRD), and local recurrence. Secondary outcomes encompass adverse events.
Results: Our search identified 905 records. Eleven studies were included in the final analyses. Data showed significantly higher en bloc resection rates with ESD (odds ratio [OR], 31.53; 95% confidence interval [CI], 10.02-99.19; P < .01; 7 studies). R0 resection rates were significantly higher with ESD (OR, 5.92; 95% CI, 2.75-12.77; P < .01; 8 studies). Curative resection rates tended to be higher with ESD (OR, 3.49; 95% CI, 0.86-14.14; P = .080; 4 studies). There was no significant difference in CRD rates (OR, 0.92; 95% CI, 0.37-2.26; P = .86; 3 studies). Local recurrence rates tended to be lower with ESD (OR, 0.35; 95% CI, 0.11-1.04; P = .058; 10 studies). As for adverse events, there was no significant difference in bleeding, perforation, and postoperative stricture rates.
Conclusions: This systematic review and meta-analysis demonstrates that ESD achieves higher en bloc, R0, and curative resection rates, with a tendency toward lower recurrence rates. These results suggest that ESD may be a more effective option for managing Barrett's neoplasia and EAC. (International Prospective Register of Systematic Reviews [PROSPERO] registration number: CRD42023426486.).
Competing Interests: Disclosure The following authors disclosed financial relationships: S. C. Grover: Research grants and personal fees from AbbVie and Ferring Pharmaceuticals; personal fees from Takeda, Sanofi, and BioJAMP; education grants from Janssen; and equity in Volo Healthcare. C. W. Teshima: Speaker for Medtronic, Fujifilm, and Boston Scientific and consultant for Boston Scientific and Olympus. All other authors disclosed no financial relationships.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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