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Comparative Study
. 2018 Jun 21;24(23):2518-2536.
doi: 10.3748/wjg.v24.i23.2518.

Comparing outcomes for endoscopic submucosal dissection between Eastern and Western countries: A systematic review and meta-analysis

Dane Christina Daoud  1 , Nicolas Suter  2 , Madeleine Durand  3 , Mickael Bouin  1 , Bernard Faulques  1 , Daniel von Renteln  1
Affiliations
Comparative Study

Comparing outcomes for endoscopic submucosal dissection between Eastern and Western countries: A systematic review and meta-analysis

Dane Christina Daoud et al. World J Gastroenterol. .

Abstract

Aim: To compare endoscopic submucosal dissection (ESD) outcomes between Eastern and Western countries.

Methods: A systematic review and meta-analysis was performed using PubMed, MEDLINE, Web of Science, CINAHL and EBM reviews to identify studies published between 1990 and February 2016. The primary outcome was the efficacy of ESD based on information about either curative resection, en bloc or R0 resection rates. Secondary outcomes were complication rates, local recurrence rates and procedure times.

Results: Overall, 238 publications including 84318 patients and 89512 gastrointestinal lesions resected using ESD were identified. 90% of the identified studies reporting ESD on 87296 lesions were conducted in Eastern countries and 10% of the identified studies reporting ESD outcomes in 2216 lesions were from Western countries. Meta-analyses showed higher pooled percentage of curative, en bloc, and R0 resection in the Eastern studies; 82% (CI: 81%-84%), 95% (CI: 94%-96%) and 89% (CI: 88%-91%) compared to Western studies; 71% (CI: 61%-81%), 85% (CI: 81%-89%) and 74% (CI: 67%-81%) respectively. The percentage of perforation requiring surgery was significantly greater in the Western countries (0.53%; CI: 0.10-1.16) compared to Eastern countries (0.01%; CI: 0%-0.05%). ESD procedure times were longer in Western countries (110 min vs 77 min).

Conclusion: Eastern countries show better ESD outcomes compared to Western countries. Availability of local ESD expertise and regional outcomes should be considered for decision making to treat gastrointestinal lesions with ESD.

Keywords: Curative resection; En bloc resection; Perforation; R0 resection.

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Conflict of interest statement

Conflict-of-interest statement: None of the authors have any potential personal conflict of interest with regard to the study to declare.

Figures

Figure 1
Figure 1
Flow diagram. The flow diagram shows the study selection process. 1One study was divided into Western and Eastern parts for our quantitative analysis (thus counting as two studies). It was however only counted as a single study when assessed for eligibility; 2Missing/incomplete data regarding our primary outcome (curative, en bloc, R0 resection); 3Non-ESD study, hybrid ESD technique, ESD with snare; 4Submucosal lesions, pharyngeal lesions; 5Case-control, case report, questionnaire. ESD: Endoscopic submucosal dissection.
Figure 2
Figure 2
Efficacy of endoscopic submucosal dissection. Forest plot for curative resection (A), en bloc resection (B) and R0 resection (C).
Figure 3
Figure 3
Complications of endoscopic submucosal dissection. Forest plot for bleeding (A), perforation (B) and perforation requiring surgery (C).
Figure 4
Figure 4
Forest plot for local recurrence.
See this image and copyright information in PMC

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