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. 2024 Nov 27;16(11):3568-3577.
doi: 10.4240/wjgs.v16.i11.3568.

Outcome and risk factors of ulcer healing after gastric endoscopic submucosal dissection: A systematic review and meta-analysis

De-Yi Chen  1 , Hai-Dong Chen  2 , Xiao-Dan Lv  3 , Zhou Huang  4 , Dan Jiang  1 , Yu Li  1 , Bing Han  1 , Li-Chun Han  1 , Xiao-Fang Xu  1 , Shi-Quan Li  1 , Guang-Fu Lin  1 , Zhi-Xi Huang  1 , Jia-Ning Lin  1 , Xiao-Ping Lv  5
Affiliations

Outcome and risk factors of ulcer healing after gastric endoscopic submucosal dissection: A systematic review and meta-analysis

De-Yi Chen et al. World J Gastrointest Surg. .

Abstract

Background: Endoscopic submucosal dissection (ESD) is widely utilized for the treatment of large adenomas, submucosal lesions, and early gastric cancer. A significant artificial ulcer typically forms after ESD. Delayed or incomplete healing of these ulcers can result in complications such as delayed bleeding and perforation. However, a comprehensive review of the outcomes and risk factors related to ulcer healing following ESD is currently lacking.

Aim: To assess ulcer healing outcomes and identify risk factors associated with delayed ulcer healing.

Methods: Databases retrieved by computer include PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang Data, and VIP. The study collects reports on ESD post-surgical ulcer healing outcomes and risk factors, using Stata 16.0 and RevMan 5.0 software for meta-analysis.

Results: Our analysis included 12 studies, involving a total of 3430 patients. The meta-analysis revealed an overall healing rate of 65.55% for ulcers following ESD [odds ratio (OR) = 2.71; 95% confidence interval (CI): 2.45-3.00]. The healing rate within eight weeks was 48.32% (OR = 0.76; 95%CI: 0.35-1.66), while the rate beyond eight weeks was 88.32% (OR = 6.73; 95%CI: 3.82-11.87). Risk factors included Helicobacter pylori (H. pylori) infection (OR: = 5.32; 95%CI: 1.90-14.87; P = 0.001), ulcer size (OR = 2.08; 95%CI: 1.19-3.61; P = 0.01), lesion site (OR = 2.08; 95%CI: 1.19-3.11), and pathological type (OR = 1.64; 95%CI: 1.06-2.52). Diabetes (OR = 0.56; 95%CI: 0.05-5.80; P = 0.63) and duration of operation (OR = 1.00; 95%CI: 0.99-1.01; P = 0.96) were not significant factors.

Conclusion: The healing rate of ulcers following ESD is high after eight weeks. Risk factors affecting the healing process include H. pylori infection, ulcer size, lesion site, and pathological type.

Keywords: Artificial ulcer; Endoscopic submucosal dissection; Gastric ulcer; Meta-analysis; Outcome; Risk factors; Systematic review.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the search and selection process.
Figure 2
Figure 2
Helicobacter pylori forest plots of various risk factors. A: Helicobacter pylori infection; B: Ulcer size; C: Lesion site; D: Pathology of lesion; E: Diabetes; F: Duration of operation. CI: Confidence interval.
See this image and copyright information in PMC

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