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Surgical Endoscopy

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01-08-2019 | Gastric Cancer | Review Article

Endoscopic submucosal dissection for early neoplastic lesions in the surgically altered stomach: a systematic review and meta-analysis

Authors: Mohamed Barakat, Mohamed Seif, Mohamed M. Abdelfatah, Andrew Ofosu, David L. Carr-Locke, Mohamed O. Othman

Published in: Surgical Endoscopy | Issue 8/2019

Abstract

Introduction and aim

Endoscopic submucosal dissection (ESD) for early gastric cancer is highly effective and well established. Performing ESD in the surgically altered stomach (SAS) is challenging. The aim of this meta-analysis is to assess the safety and efficacy of ESD for patients with early neoplastic lesions occurring in the SAS with a subgroup analysis of lesions occurring on the suture line compared to non-suture line lesions and outcomes in the remnant stomach compared to the gastric tube.

Methods

We performed a literature search of the PubMed, Embase, and CINAHL electronic databases from January 2000 to November 2017 for articles reporting the safety and efficacy of ESD in the surgically altered stomach. SAS was defined as the remnant stomach following gastrectomy and gastric tube following esophagectomy. Meta-analysis was performed using Review Manager version 5.3 software.

Results

A total of 21 articles, with 903 lesions occurring in the remnant stomach or gastric tube, were included in this study. There was no significant difference between en bloc (RR 0.99, 95% CI 0.91–1.08), curative resection (RR 1.03, 95% CI 0.84–1.26), or bleeding rates (RR 1.40, 95% CI 0.18–10.72) between lesions in the remnant stomach and gastric tube. However, perforation was significantly higher in the gastric tube (RR 5.19, 95% 1.27–21.25). Suture line lesions had a significantly higher risk of perforation (RR 4.55, 95% CI 2.13–9.74).

Conclusion

ESD for early neoplastic lesions occurring in the SAS is a safe and efficacious with similar en bloc and curative resection rates compared to the anatomically normal stomach. ESD for lesions on the suture line or in the gastric tube is associated with an increased risk of perforation which can be managed endoscopically.

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Title: Endoscopic submucosal dissection for early neoplastic lesions in the surgically altered stomach: a systematic review and meta-analysis
Authors: Mohamed Barakat
Mohamed Seif
Mohamed M. Abdelfatah
Andrew Ofosu
David L. Carr-Locke
Mohamed O. Othman
Publication date: 01-08-2019
Publisher: Springer US
Keywords: Gastric Cancer
Gastric Cancer
Published in: Surgical Endoscopy / Issue 8/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-06778-y

At a glance: The STEP trials

Springer Medicine

Endoscopic submucosal dissection for early neoplastic lesions in the surgically altered stomach: a systematic review and meta-analysis

Abstract

Introduction and aim

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction and aim

Methods

Results

Conclusion

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