Clin Endosc.  2021 Mar;54(2):202-210. 10.5946/ce.2020.121.

Endoscopic Submucosal Dissection versus Surgery for Undifferentiated-Type Early Gastric Cancer: A Systematic Review and Meta-Analysis

• Huh CW
• Ma DW
• Kim BW
• Kim JS
• Lee SJ

• KMID: 2514174
• DOI: http://doi.org/10.5946/ce.2020.121

Abstract

Background/Aims
The use of endoscopic submucosal dissection (ESD) for treating undifferentiated-type early gastric cancer is controversial. The objective of this study was to perform a meta-analysis to compare the long-term outcomes of ESD and surgery for undifferentiated-type early gastric cancer.
Methods
The PubMed, Cochrane Library, and EMBASE databases were used to search for relevant studies comparing ESD and surgery for undifferentiated-type early gastric cancer. The methodological quality of the included publications was evaluated using the Risk of Bias Assessment tool for Nonrandomized Studies. The rates of overall survival, recurrence, adverse event, and complete resection were determined. Odds ratios (ORs) and 95% confidence intervals (CIs) were also evaluated.
Results
This meta-analysis enrolled five studies with 429 and 1,236 participants undergoing ESD and surgery, respectively. No significant difference was found in the overall survival rate between the ESD and surgery groups (OR, 2.29; 95% CI, 0.98–5.36; p=0.06). However, ESD was associated with a higher recurrence rate and a lower complete resection rate. The adverse event rate was similar between the two groups.
Conclusions
ESD with meticulous surveillance esophagogastroduodenoscopy may be as effective and safe as surgery in patients with undifferentiated-type early gastric cancer. Further large-scale, randomized, controlled studies from additional regions are required to confirm these findings.

Keyword

Endoscopic submucosal dissection; Gastric neoplasm; Meta-analysis; Surgery

Figure

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  Fig. 1. Search strategy flowchart. EGC, early gastric cancer; ESD, endoscopic submucosal dissection.

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  Fig. 2. Risk of bias of the enrolled studies.

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  Fig. 3. Forest plot of complete resection rate comparing endoscopic submucosal dissection (ESD) and surgery. CI, confidence interval.

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  Fig. 4. Forest plot of adverse event rate comparing endoscopic submucosal dissection (ESD) and surgery. CI, confidence interval.

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  Fig. 5. Forest plot of recurrence rate comparing endoscopic submucosal dissection (ESD) and surgery. CI, confidence interval.

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  Fig. 6. Forest plot of overall survival rate comparing endoscopic submucosal dissection (ESD) and surgery. CI, confidence interval.

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  Fig. 7. Subgroup analysis in undifferentiated-type early gastric cancer within the expanded indications. (A) Forest plot of overall survival rate. (B) Forest plot of recurrence rate. (C) Forest plot of complete resection rate. CI, confidence interval; ESD, endoscopic submucosal dissection.

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