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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(05): E694-E702
DOI: 10.1055/a-1789-0548
Review

Effectiveness and safety of endoscopic submucosal dissection using the pocket creation method in the Japanese population: a systematic review and meta-analysis

Satoshi Shinozaki
1   Shinozaki Medical Clinic, Utsunomiya, Japan
2   Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
,
Yoshikazu Hayashi
2   Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
,
Yoshimasa Miura
2   Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
,
Tomonori Yano
2   Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
,
Alan Kawarai Lefor
3   Department of Surgery, Jichi Medical University, Shimotsuke, Japan
,
Hironori Yamamoto
2   Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
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Abstract

Background and study aims Endoscopic submucosal dissection (ESD) is a standard method for minimally invasive resection of superficial gastrointestinal tumors. The pocket creation method (PCM) facilitates ESD regardless of location in the gastrointestinal tract. The aim of this systematic review and meta-analysis is to evaluate the effectiveness and safety of ESD for superficial neoplasms in the upper and lower gastrointestinal tract comparing the PCM to the non-PCM.

Methods Randomized controlled, prospective, and retrospective studies comparing the PCM with the non-PCM were included. Outcomes included en bloc resection, R0 resection, dissection speed, delayed bleeding and perforation. Pooled odds ratios (ORs) with 95 % confidence intervals (CIs) using the Mantel-Haenszel random effect model were documented.

Results Eight studies including gastric, duodenal, and colorectal ESD were included. The en bloc resection rate was significantly higher in the PCM group than the non-PCM group (OR 3.87, 95 %CI 1.24–12.10 P = 0.020). The R0 resection rate was significantly higher in the PCM group than the non-PCM group (OR 2.46, 95 %CI 1.14–5.30, P = 0.020). The dissection speed was significantly faster in the PCM group than the non-PCM group (mean difference 3.13, 95 % CI 1.35–4.91, P < 0.001). The rate of delayed bleeding was similar in the two groups (OR 1.13, 95 %CI 0.60–2.15, P = 0.700). The rate of perforation was significantly lower in the PCM group than the non-PCM group (OR 0.34, 95 %CI 0.15–0.76, P = 0.009).

Conclusions The PCM facilitates high-quality, fast and safe colorectal ESD. Further studies are needed regarding the utility of PCM in ESD of the upper gastrointestinal tract.

Supplementary material



Publication History

Received: 12 July 2021

Accepted after revision: 10 November 2021

Article published online:
13 May 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2022; 54(06): 631-631
DOI: 10.1055/a-1748-1088

 

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