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Meta-Analysis
. 2021 Dec 23;100(51):e28396.
doi: 10.1097/MD.0000000000028396.

Risk factors of postoperative stricture after endoscopic submucosal dissection for superficial esophageal neoplasms: A meta-analysis

Nan Lin  1 , Jie Lin, Jinrong Gong
Affiliations
Meta-Analysis

Risk factors of postoperative stricture after endoscopic submucosal dissection for superficial esophageal neoplasms: A meta-analysis

Nan Lin et al. Medicine (Baltimore). .

Abstract

Background: As larger-sized superficial esophageal neoplasms became candidates for endoscopic submucosal dissection (ESD), post-ESD esophageal stricture has inevitably developed into a significant complication during long-term follow-up.

Method: The PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Web of Science, as well as China National Knowledge Infrastructure, the Wanfang Database, and the Chinese Biomedical Literature Database, were searched to identify all the appropriate studies published from January 2000 through October 2019. For risk factor assessment between postoperative stricture and control groups, pooled odds ratios (OR) and weighted mean differences (WMD) estimation was done. All meta-analytical procedures were conducted by using Stata version 15.1 software.

Results: The results showed that 11 studies with 2248 patients (284 structure cases and 1964 controls) were eligible for this meta-analysis. Statistical results indicated 6 substantial risk factors: lesion characteristics involving the upper third of the esophagus (OR 1.51, [1.02-2.25]), macroscopic type of IIa/IIc (OR 2.76, [1.55-4.92]), tumor depth of invasion above m1 (OR 7.47, [3.31-16.86]), and m2 (OR 12.67, [4.00-40.10]), longitudinal length (WMD 13.75 mm, [7.76-19.74]), circumferential diameter (WMD 10.87 mm, [8.13-13.60]), and circumferential range >3/4 (OR 38.17, [9.94-146.52]). Each additional 10% of the circumferential range increased the risk of stricture by 149% (OR 9282.46, [978.14-88089.35]).

Conclusions: Six risk factors were assessed to have a key role in the elevated risk levels of post-ESD esophageal stricture. The results can help doctors identify patients with increased risk and thus can guide management of the adequate period of surveillance after ESD and take available approaches of stricture prevention.

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Conflict of interest statement

Disclosure: The PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, as well as China National Knowledge Infrastructure, the Wanfang Database, and the Chinese Biomedical Literature Database are public databases. The patients involved in the database have obtained ethical approval. Users can download relevant data for research and publish relevant articles. Our study is based on open source data, so there are no ethical issues and other conflicts of interest. The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram of literature search and study selection.
Figure 2
Figure 2
Risk factors of categorical variables for postoperative stricture after ESD. ESD = endoscopic submucosal dissection.
Figure 3
Figure 3
Risk factors of continuous variables for postoperative stricture after ESD. ESD = endoscopic submucosal dissection.
Figure 4
Figure 4
Dose–response association between circumferential range and risk of postoperative stricture after ESD. The solid line and long dashed lines represent the estimated OR and it is 95% CI. CI = confidence intervals, ESD = endoscopic submucosal dissection, OR = odds ratios.
Figure 5
Figure 5
Egger funnel plot for publication bias analysis for age and risk of postoperative stricture after ESD. ESD = endoscopic submucosal dissection.
Figure 6
Figure 6
Egger funnel plot for publication bias analysis for tumor location and the risk of postoperative stricture after ESD. ESD = endoscopic submucosal dissection.
See this image and copyright information in PMC

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