Endoscopic submucosal dissection of gastric tumors: A systematic review and meta-analysis

Table 3 Rates of adverse outcomes in patients undergoing gastric endoscopic submucosal dissection between 1998 and 2014

Adverse outcomes	Studies, n	Patients, n	Tumor, n	Rate (95%CI), %1
Immediate2
Perforation3	66	24855	27118	2.7 (2.1, 3.3)
Major bleeding4	19	3815	3943	2.9 (1.3, 6.6)
Delayed5
Perforation	13	2570	2852	0.39 (0.06, 2.4)
Major bleeding6	63	21612	23338	3.6 (3.1, 4.3)
Recurrence7
Among tumors with R0	17	-	2027	0.02 (0.001, 1.4)
Among tumors without R0	13	-	203	7.7 (3.6, 16)
Irrespective of R0 status8	33	11256	12398	0.75 (0.42, 1.3)

¹The rates are calculated as a percentage of the total number of tumors operated;

²Immediate refers to adverse outcomes occurring within 24 h of the procedure;

³The rate (95%CI) of immediate perforation was significantly lower with epithelial [2.7% (2.2%-3.6%)] compared with subepithelial tumors [8.9% (2.7%-15%)] (P = 0.02) and declined by 0.29% (0.05%-0.54%) per year over the duration of study (P = 0.02);

⁴The rate (95%CI) of major immediate bleeding declined by 2.3% (0.72%-3.9%) per year over the duration of study (P = 0.007);

⁵Delayed refers to adverse outcome occurring 24 h after the procedure;

⁶The rate (95%CI) of delayed bleeding increases by 1.3% (0.07%-2.5%) for every 10 year increase in age;

⁷Average follow-up was 26, 28 and 32 mo for assessment of recurrence among tumors with R0, without R0, and irrespective of R0 status respectively;

⁸The rate (95%CI) of recurrence decreases by 0.4% (0.1%-0.7%) for every 10 year increase in age (P = 0.01) and there was a trend towards higher rate in Western countries [5.1% (0.5%-11%)] compared with Asia [0.5% (0.3%-0.6%)] (P = 0.06). R0: Histologically-confirmed en bloc resection.