Meta-Analysis
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World J Gastroenterol. May 14, 2014; 20(18): 5540-5547
Published online May 14, 2014. doi: 10.3748/wjg.v20.i18.5540
Endoscopic submucosal dissection vs endoscopic mucosal resection for superficial esophageal cancer
Hui-Min Guo, Xiao-Qi Zhang, Min Chen, Shu-Ling Huang, Xiao-Ping Zou
Hui-Min Guo, Xiao-Qi Zhang, Min Chen, Shu-Ling Huang, Xiao-Ping Zou, Department of Gastroenterology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Author contributions: Guo HM and Zou XP designed the research; Chen M and Huang SL completed the literature search; Guo HM, Zhang XQ and Chen M analyzed the data; Guo HM and Zhang XQ wrote the paper.
Correspondence to: Xiao-Ping Zou, PhD, Department of Gastroenterology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, Jiangsu Province, China. zouxiaoping795@hotmail.com
Telephone: +86-25-83106666 Fax: +86-25-83105321
Received: August 26, 2013
Revised: December 13, 2013
Accepted: January 19, 2014
Published online: May 14, 2014
Abstract

AIM: To investigate the effectiveness of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) in treating superficial esophageal cancer (SEC).

METHODS: Studies investigating the safety and efficacy of ESD and EMR for SEC were searched from the databases of Pubmed, Web of Science, EMBASE and the Cochrane Library. Primary end points included the en bloc resection rate and the curative resection rate. Secondary end points included operative time, rates of perforation, postoperative esophageal stricture, bleeding and local recurrence. The random-effect model and the fixed-effect model were used for statistical analysis.

RESULTS: Eight studies were identified and included in the meta-analysis. As shown by the pooled analysis, ESD had significantly higher en bloc and curative resection rates than EMR. Local recurrence rate in the ESD group was remarkably lower than that in the EMR group. However, operative time and perforation rate for ESD were significantly higher than those for EMR. As for the rate of postoperative esophageal stricture and procedure-related bleeding, no significant difference was found between the two techniques.

CONCLUSION: ESD seems superior to EMR in the treatment of SEC as evidenced by significantly higher en bloc and curative resection rates and by obviously lower local recurrence rate.

Keywords: Superficial esophageal cancer, Endoscopic mucosal resection, Endoscopic submucosal dissection, Meta-analysis

Core tip: This meta-analysis was performed on the basis of previously published reports aiming to compare endoscopic submucosal dissection (ESD) with endoscopic mucosal resection (EMR) in treating superficial esophageal cancer. Eight studies involving 1081 patients were analyzed. Of those, 448 lesions were treated by ESD and 744 were treated by EMR. Compared with EMR, ESD had significantly higher overall en bloc and curative resection rates, and lower local recurrence rate. There was no significant difference in the complication rate between the two methods.