Endoscopic submucosal dissection and EMR for early gastric cancer

The most recent issue of the Gastrointestinal Endoscopy performed a meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer

Endoscopic submucosal dissection was developed to overcome the problem caused by incomplete resection by conventional EMR for early gastric cancer.

The technique of endoscopic submucosal dissection had a relative higher incidence rate of complications such as bleeding and perforation because of its large wound incidence and difficulties.

Dr Jingjing Lian and colleagues from China evaluated the efficacy and safety of endoscopic submucosal dissection and EMR for early gastric cancer.

The team made an overall strategy to search various databases both electronically and manually and assessed the quality of selected articles according to the inclusion and exclusion standard.

The researchers performed a meta-analysis of 9 retrospective studies.

The endoscopic submucosal dissection group had lower recurrence frequency

Gastrointestinal Endoscopy

The patients included 3548 lesions.

Intervention method was endoscopic submucosal dissection or EMR.

The team's main outcome measurements included en bloc resection rate, histologic curative resection rate, complications, and recurrence rate.

The research team identified 9 retrospective studies.

A total of 3548 lesions were enrolled.

The mean time required for resection was longer for endoscopic submucosal dissection  than for EMR.

The en bloc rate in the endoscopic submucosal dissection group was significantly higher than that in the EMR group, and so was the total histologically complete resection rate.

The research team observed that the endoscopic submucosal dissection group had lower recurrence frequency.

The team noted that the perforation rate was higher in the endoscopic submucosal dissection  group, whereas the bleeding incidences were similar between the two groups.

Dr Lian's team concluded, "Compared with EMR for early gastric cancer, endoscopic submucosal dissection showed considerable advantages regarding en bloc resection rate, histologically complete resection rate, and local recurrence even for small lesions, but it had the disadvantages of higher complication rates for perforation."

"All of the results mentioned should be confirmed by well-designed, randomized, controlled trials from more countries, with larger samples and long enough follow-up periods."