Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2015; 21(19): 6032-6043
Published online May 21, 2015. doi: 10.3748/wjg.v21.i19.6032
Endoscopic submucosal dissection for early gastric cancer with undifferentiated-type histology: A meta-analysis
Chang Seok Bang, Gwang Ho Baik, In Soo Shin, Jing Bong Kim, Ki Tae Suk, Jai Hoon Yoon, Yeon Soo Kim, Dong Joon Kim, Woon Geon Shin, Kyung Ho Kim, Hak Yang Kim, Hyun Lim, Ho Seok Kang, Jong Hyeok Kim, Jin Bae Kim, Sung Won Jung, Sea Hyub Kae, Hyun Joo Jang, Min Ho Choi
Chang Seok Bang, Gwang Ho Baik, Jing Bong Kim, Ki Tae Suk, Jai Hoon Yoon, Yeon Soo Kim, Dong Joon Kim, Woon Geon Shin, Kyung Ho Kim, Hak Yang Kim, Hyun Lim, Ho Seok Kang, Jong Hyeok Kim, Jin Bae Kim, Sung Won Jung, Sea Hyub Kae, Hyun Joo Jang, Min Ho Choi, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 200-704, South Korea
In Soo Shin, College of Education, Jeonju University, Jeonju 560-759, South Korea
Author contributions: Baik GH and Bang CS designed research; Bang CS, Shin IS, Suk KT, Yoon JH, Kim YS, Shin WG, Kim KH, Lim H, Kang HS, Jung SW, Kae SH, Jang HJ and Choi MH performed research; Kim JB, Kim DJ, Kim HY, Kim JH and Kim JB contributed new reagent/analytic tools; Bang CS and Baik GH analyzed data; and Bang CS wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gwang Ho Baik, MD, Department of Internal Medicine, Hallym University College of Medicine, Kyo-dong, Chuncheon 200-704, South Korea. baikgh@hallym.or.kr
Telephone: +82-33-2405821 Fax: +82-33-2418064
Received: September 3, 2014
Peer-review started: September ??, 2014
First decision: September 30, 2014
Revised: October 1, 2014
Accepted: November 19, 2014
Article in press: November 19, 2014
Published online: May 21, 2015
Abstract

AIM: To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) with undifferentiated-type histology.

METHODS: A systematic literature review was conducted using the core databases. Complete resection, curative resection, en bloc resection, recurrence and adverse event rate were extracted and analyzed. A random effect model was applied. The methodological quality of the enrolled studies was assessed using the Newcastle-Ottawa Scale. Publication bias was evaluated using a funnel plot, the trim and fill method, Egger’s test, and a rank correlation test.

RESULTS: Fourteen retrospective studies between 2009 and 2014 were identified (972 EGC lesions with undifferentiated-type histology). The total en bloc and complete resection rates were estimated as 92.1% (95%CI: 87.4%-95.2%) and 77.5% (95%CI: 69.3%-84%), respectively. The total curative resection rate was 61.4% (95%CI: 44.5%-75.9%). The overall recurrence rate was 7.6% (95%CI: 3.4%-16%). Limited to histologically diagnosed expanded-criteria lesions, the en bloc and complete resection rates were 91.2% and 85.6%, respectively. The curative resection rate was 79.8%.

CONCLUSION: In this analysis, ESD is a technically feasible treatment modality for EGC with undifferentiated-type histology. Long-term studies are needed to confirm these therapeutic outcomes.

Keywords: Carcinoma, Endoscopic submucosal dissection, Endoscopy, Gastric cancer, Meta-analysis

Core tip: Controversies regarding proposed expansions of the indication for endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) with undifferentiated-type histology still remain. In this meta-analysis, ESD is a technically feasible treatment modality for EGC with undifferentiated-type histology. However, cautious interpretation is needed because of heterogeneity among studies. Inconsistent implementation of indication, insufficient follow-up duration, and different outcome criteria are causes of heterogeneity. Further studies using common primary outcomes or large-scale, long-term studies will elucidate the feasibility of ESD for EGC with undifferentiated-type histology.