Impact of formal training in endoscopic submucosal dissection for early gastrointestinal cancer: A systematic review and a meta-analysis

Abstract

Aim: To summarize the clinical impact of a formal training for the effectiveness and safety of endoscopic submucosal dissection for gastrointestinal cancer.

Methods: We searched databases including PubMed, EMBASE and the Cochrane Library and Science citation Index updated to August 2014 to include eligible articles. In the Meta-analysis, the main outcome measurements were en bloc resection rate, local recurrence rate (R0) and the incidence of procedure-related complications (perforation, bleeding).

Results: En bloc resection was high for both, dissecting stomach tumors with an overall percentage of 93.2% (95%CI: 90.5-95.8) and dissecting colorectal tumors with an overall percentage of 89.4% (95%CI: 85.1-93.7). Although the number of studies reporting R0 resection (the dissected specimen was revealed free of tumor in both vertical and lateral margins) was small, the overall estimates for R0 resection were 81.4% (95%CI: 72-90.8) for stomach and 85.9% (95%CI: 77.5-95.5) for colorectal tumors, respectively. The analysis showed that the percentage of immediate perforation and bleeding were very low; 4.96 (95%CI: 3.6-6.3) and 1.4% (95%CI: 0.8-1.9) for colorectal tumors and 3.1% (95%CI: 2.0-4.1) and 4.8% (95%CI: 2.8-6.7) for stomach tumors, respectively.

Conclusion: In order to obtain the same rate of success of the analyzed studies it is a necessity to create training centers in the western countries during the "several years" of gastroenterology residence first only to teach EGC diagnose and second only to train endoscopic submucosal dissection.

Keywords: Endoscopic submucosal dissection; Training.

Figure 1

Flow diagram of trial selection and en-bloc resection percentage %. A: Flow diagram of trial selection; B: Stomach ESD: En-bloc resection percentage %; C: Colorectal ESD: En-bloc resection percentage %; D: Stomach ESD: Local recurrence (R0) rate %; E: Colorectal ESD: Local recurrence (R0) rate %; F: Stomach ESD: Perforation rate %; G: Colorectal ESD: Perforation rate %; H: Stomach ESD: Bleeding rate %; I: Colorectal ESD: Bleeding rate %. MeSH: Medical Subject Heading; ESD: Endoscopic submucosal dissection.