Published online Mar 27, 2025. doi: 10.4240/wjgs.v17.i3.100920
Revised: December 31, 2024
Accepted: January 21, 2025
Published online: March 27, 2025
Processing time: 178 Days and 0 Hours
Esophageal stricture is a prevalent condition affecting the digestive system, primarily marked by dysphagia and the obstruction of food passage through the esophagus. This narrowing of the esophageal lumen can significantly impact a person’s ability to eat and drink comfortably, often leading to a decrease in nutritional intake and quality of life.
To explore the current research status and future trends of esophageal stricture through bibliometric analysis.
Literature on esophageal stricture from 2004 to 2023 was retrieved from the Web of Science Core Collection. Statistical analysis was performed using Excel, VOS
The study included 1485 publications written by 7469 authors from 1692 institu
This study provides an insightful analysis of the developments in the field of esophageal stricture over the past twenty years, with stent placement is currently a hot research topic.
Core Tip: This comprehensive bibliometric study offers an in-depth summary and analysis of 1485 publications authored by 7469 researchers from 66 countries, highlighting the leading contributions from the United States, China, and Japan. The study uncovers pivotal trends and emerging focal points in esophageal stricture research, particularly emphasizing breakthroughs in stent placement techniques, significant progress in regenerative medicine, the expanding role of endoscopic injection therapies, and the promising potential of autologous tissue transplantation. These insights are poised to influence and shape future therapeutic strategies and decision-making processes in the field.
- Citation: Wang XY, Chen HY, Sun Q, Li MH, Xu MN, Sun T, Huang ZH, Zhao DL, Li BR, Ning SB, Fan CX. Global trends and research hotspots in esophageal strictures: A bibliometric study. World J Gastrointest Surg 2025; 17(3): 100920
- URL: https://www.wjgnet.com/1948-9366/full/v17/i3/100920.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v17.i3.100920
Esophageal stricture is a prevalent digestive disorder characterized by narrowing of the esophagus, which impedes the passage of food and liquids. Esophageal strictures can be classified as either congenital or acquired based on their etiology and pathological features. Congenital esophageal stricture is an uncommon deformity characterized by narrowing of the lower esophagus due to intramural constriction[1]. In contrast, acquired esophageal stricture is caused primarily by fibrosis and scar formation in the esophageal wall and is typically induced by esophageal inflammation, ulcers, tumors, or surgery[2]. Clinically, treatment options for congenital esophageal stricture include dilation and surgical intervention. The treatment of acquired esophageal stricture encompasses a range of options, including pharmacological interventions, endoscopic procedures, and surgical techniques. The choice of treatment depends largely on the cause, severity of the stricture, patient’s overall health, and anticipated quality of life. Epidemiological studies have shown a globally increasing incidence of this disease, which is likely attributed to various factors, including lifestyle changes, unbalanced diets, and environmental contamination[3]. This disease is most prevalent among middle-aged and elderly individuals, although children and adolescents may also be affected[4]. The diagnosis of esophageal stricture relies heavily on endoscopy and esophagography. Endoscopy allows direct visualization of the site, length of the stricture, and pathological changes in the esophageal wall[5]. Esophagography provides a comprehensive overview of the esophagus, including its morphology, location, and degree and extent of the stricture[6]. Esophageal manometry and esophageal dynamics are used to evaluate the functional status of the esophagus and determine the stricture etiology[7]. The pathogenesis of esophageal stricture is driven primarily by inflammatory and fibrotic processes. Inflammation in the esophageal wall causes tissue damage and cell death, triggering cellular proliferation and extracellular matrix deposition, ultimately leading to scarring fibrosis and narrowing of the esophagus[8]. Additionally, diseases such as gastroesophageal reflux disease (GERD), esophageal atresia, and esophageal cancer can result in esophageal stricture through similar mechanisms. Symptoms such as dysphagia, chest pain, and weight loss are indicative of esophageal stricture, with severity correlated with to the degree and extent of the stricture. In recent years, there has been a scarcity of guidelines in the field of esophageal stricture, leading to insufficient systematic guidance in clinical practice. Although case studies from individual institutions provide specialized knowledge, they do not offer a sufficient number of patients for effective care evaluation; this underscores the difficulties in advancing the knowledge of rare diseases. To address this gap, a comprehensive bibliometric approach has proven effective[9]. This method systematically analyzes the literature and identifies research hotspots and trends, providing a scientific foundation for future research and guideline development.
This study encompasses all research on esophageal stricture published over the past two decades. Various parameters, such as the number of publications, geographical distribution, authors, institutions, journals, references, and keywords, were analyzed[10,11]. This approach aims to provide a comprehensive understanding of the current state of research in this field. Additionally, a case of esophageal stricture caused by chemical corrosion was presented. Despite severe damage, two metal stents were successfully placed in the upper esophagus. Our objective is to produce a structured statistical report that offers a comprehensive overview, aids researchers in making informed decisions regarding esophageal stricture, and contributes to advancements in the field.
The database is derived from Clarivate Analytics’ Web of Science Core Collection (WoSCC) Science Citation Index Expanded. WoSCC is one of the most widely utilized databases in academic research, providing comprehensive data on numerous prominent journals and publications globally[12]. WoSCC was selected as the primary source for this study due to its extensive coverage of numerous academic journals and its frequent utilization by researchers. We searched WoSCC to identify all studies related to esophageal strictures with a data collection deadline of March 20, 2024. The time frame was limited to the last two decades, and the language to English. Publication types were restricted to articles and reviews, excluding conference abstracts, editorial material, letters, news reports, and book reviews. To ensure data accuracy and consistency, two independent reviewers conducted the search using the described method. Figure 1 and Supplementary Table 1 display the specific search strategy, and we exported all the obtained literature in plain text and Excel formats.
All graphs were obtained using Microsoft Excel 2021 (version 16.52), CiteSpace (version 6.1.6 R2, RRID: SCR_025121), VOSviewerr (version 1.6.18, RRID: SCR_023744), and RStudio software (version R-4.2.2, RRID: SCR_023744) with the bibliometric package[13]. The results are presented in three types of visualizations: Network with clusters, network with timeline, and clustering visualization. The literature information was imported into Microsoft Excel 2021, from which the following data were extracted for each publication: Author, title, journal source, the journal impact factor (derived from the Journal Citation Report 2023), keywords, citations, references, author’s organization, author’s country/region, co-cited authors, and co-cited journals.
CiteSpace (version 6.1.6 R2), developed by Dr. Chao-Mei Chen of Drexel University, United States. The software utilizes Java to visualize and analyze scientific references. CiteSpace is one of the most popular bibliometric tools for identifying evolving research topics and is commonly used to detect key authors, institutions, keywords, and co-cited references[13]. Bursts have been defined as a feature that has been frequently cited over time. Additionally, CiteSpace generates dual maps of journal citation relationships[14].
VOSviewer, another robust visualization tool, conducts scientific mapping analysis of publications[15]. It extracts essential information from high-frequency fields such as country/region, institution, author, journal, and keywords. Through bibliometric analysis, VOSviewer visually represents data in an easily understandable graphical format. Network maps are created to identify trends in research fields and measure the degree of collaboration. These visual network maps are interpreted based on four features: Size, color, distance, and connection line thickness. Nodes represent specific terms such as countries, authors, or keywords. Larger nodes indicate higher frequency, while smaller nodes indicate lower frequency. Different colors represent different sub-clusters within the field, the distance between nodes indicates correlation (closer nodes indicate higher correlation), and the thickness of the connection line represents the strength of collaboration between nodes. Data were standardized before being imported to VOSviewer to generate images, with different expressions related to the same author or keyword being unified to reduce bias.
Bibliometric analysis was conducted using the “bibliometrix” R package within the RStudio environment for most locally cited references and keywords. The bibliometrix package facilitated the extraction and analysis of high-frequency fields. Data standardization ensured consistency and accuracy, with visualizations like network maps used to identify research trends and measure collaboration strength. The features in the visualizations, such as node size, color, distance, and connection line thickness, were interpreted to represent frequency, clustering, correlation, and collaboration strength. Further validation of the visualized information was performed using VOSviewer and CiteSpace.
Over the past two decades, research on esophageal stricture has shown a gradual overall increasing trend (Figure 2A), with the number of publications increasing from 43 in 2004 to 97 in 2023. This finding indicates growing attention and research interest in the field of esophageal stricture. Despite fluctuations in the growth rate, the overall trend demonstrates positive development, providing a solid foundation for future research and exploration (Figure 2B). This growth trend may reflect the academic community’s increased emphasis on esophageal stricture issues and the rise in research investments, suggesting potential development opportunities and the importance of continued research in this field.
The research papers in this field originate from 66 countries/regions, with the United States contributing the most (356 papers, accounting for 23.98%), followed by China (278 papers, 18.72%), Japan (206 papers, 13.87%), Turkey (81 papers, 5.45%), and England (65 papers, 4.38%) (Figure 3A). In terms of citations, the United States leads with 10740, followed by Japan (5749), China (2620), France (1754), and Germany (1601). With respect to centrality, the United States ranks first (0.26), followed by England (0.21), Japan (0.10), Denmark (0.10), and Italy (0.08). Supplementary Table 2 Lists the publications, citation counts, and centralities of these 66 countries. Using VOSviewer, a collaboration and global distribution map was created based on the cooperation between countries. Figure 3B displays a visual map of collaborations between different countries, where the nodes size indicates the connection strength. Larger nodes represent stronger connections and tighter cooperation. The United States shows the most active collaboration with other countries, with the highest total link strength (TLS = 76), and the closest cooperation is between the United States and China (TLS = 21).
A total of 1692 institutions have contributed to this research field. As shown in Figure 3C, the top 10 institutions ranked by the number of publications are led by Mayo Clinic (27 publications), Harvard University (25 publications), Université Paris Cité (25 publications), the University of California System (25 publications), and Assistance Publique Hôpitaux Paris (24 publications). In terms of citation counts, Mayo Clinic ranks first with 2169 citations, Harvard University ranks second with 1525 citations, and the University of California System ranks third with 1475 citations. Supplementary Table 3 Lists the top 60 institutions by publication count, citation count, and centrality. VOSviewer was used to analyze the collaboration between institutions. Figure 3D presents a visual map of collaboration between different institutions, with the thickness of the connecting lines representing the strength of cooperation. Among the institutions, the Mayo Clinic (TLS = 47) and the University of Pennsylvania (TLS = 44) maintain close collaboration with each other.
Many scholars are dedicated to researching esophageal strictures. Using the analysis tools of the WoSCC, 7469 authors were found to have participated in this field. Supplementary Table 4 Lists the top 15 authors ranked by publication volume. Figure 3E shows that Song Ho-Young (Song HY) is the leading author, with 15 articles. Figure 3F shows the collaborative relationships among the top authors. Song HY, Park Jung-Hoo (Park JH, publication = 10), and Shin Ji Hoon (Shin JH, publication = 10), affiliated with the University of Ulsan, are involved in a collaborative endeavor focused on fluoroscopically guided significant balloon dilatation for the treatment of congenital esophageal stenosis. Yamato Masayuki (Yamato M, publication = 11), Ohki Takeshi (Ohki T, publication = 10), Takagi, Ryo (Takagi R, publication = 10), Okano Teruo (Okano T, publication = 9), Yamamoto Masakazu (Yamamoto M, publication = 9) and Kanai, Nobuo (Kanai N, publication = 9) from Tokyo Women’s Medical University are prominent in research on tissue engineering and regenerative medicine. Manfredi Michael A (Manfredi MA, publication = 10), Ngo Peter D (Ngo PD, publication = 9), and Zendejas Benjamin (Zendejas B, publication = 9) from Boston Children’s Hospital primarily focus on pediatric esophageal strictures. Overall, these researchers cover a range of clinical studies on esophageal strictures and emerging fields in regenerative medicine. Notably, research on the pathophysiological mechanisms of esophageal strictures is relatively rare.
A total of 417 journals have published these publications. Among them, 224 journals (53.72%) published only one related article, 141 journals (33.81%) published between two and five, and 52 journals (12.47%) published six or more articles. Figure 3G displays the ten most productive journals. Diseases of the Esophagus (86 articles) is the leading journal, followed by Surgical Endoscopy and other Interventional Techniques (70 articles). The top 10 most productive journals account for 30% of the total publications in this field. The mean impact factor of these top 10 journals is 3.96. Citation analysis revealed that 33 journals had more than 100 citations (Supplementary Table 5), with Gastrointestinal Endoscopy leading with 2128 citations. To examine the distribution of citing and cited journals, we employed a dual map overlay analysis (Figure 3H). The map on the left represents the citing journals, whereas the map on the right represents the cited journals. The labels on the map indicate the topics covered by the journals, and colorful curves illustrate the reference paths from the citing journals (e.g., medicine, medical and clinical) to the cited journals (e.g., health, nursing, and medicine).
Among the 1485 publications, the top 10 most cited articles focused on endoscopic evaluation (Supplementary Table 6), treatment methods (e.g., radiofrequency ablation by Shaheen et al[16]), eosinophilic esophagitis (e.g., Hirano et al[17]), and tissue engineering (e.g., Ohki et al[18]), predominantly from the United States and Japan. The United States emphasizes Barrett’s esophagus and GERD, whereas Japan focuses on endoscopic submucosal dissection (ESD) and tissue engineering. Articles in prestigious journals (New England Journal of Medicine, Gut, and Gastroenterology) such as Shaheen et al’s study[16] with 1007 citations, illustrating leadership in the field, have high scientific impact. Seminal works such as Kovesi et al’s paper[19] demonstrate enduring academic value, whereas emerging technologies, including ESD and tissue engineering, indicate the field’s progress toward precise treatments. Key studies, such as Yamaguchi et al’s work[20] on oral prednisone post-ESD and Stadlhuber et al’s work[21] on prosthesis complications, reflect the integration of basic research with clinical applications and interdisciplinary collaboration.
Figure 4A highlights influential papers published between 2003 and 2012, with peaks in 2009 and 2011. Notably, two works by Ono et al[22] in 2009 and one by Yamaguchi et al[20] in 2011 are foundational to the field. Citation bursts (Figure 4B) indicate widespread attention from 2004 to 2023, with a focus on endoscopic techniques such as ESD and radiofrequency ablation, as seen in studies by Ono et al[22] in 2009 and Takahashi et al[23] in 2011. Innovative works, such as Ohki et al’s research[18] in 2012 on tissue-engineered applications and Liacouras et al’s study[24] in 2011 of eosinophilic esophagitis, significantly influence academia and clinical practice. These impactful studies shape research directions and directly inform treatment strategies, such as the use of oral prednisone and tissue-engineered cell sheets.
Keyword analysis via VOSviewer identified seven clusters related to esophageal stricture research (Figure 5A). Cluster 1 (red) included keywords such as Barrett’s esophagus, eosinophilic esophagitis, and esophageal adenocarcinoma, reflecting diseases associated with esophageal stricture. Cluster 2 (green) focuses on regenerative medicine, cell sheets, and scaffolds, highlighting new treatment applications. Cluster 3 (blue) covers methods such as endoscopic dilation and steroid injection for treating strictures. Cluster 4 (yellow) included terms such as proton pump inhibitors and collagen, detailing substances used in treatment. Cluster 5 (purple) relates to clinical trials and efficacy. Cluster 6 (light blue) reflects patient populations and experimental models, whereas Cluster 7 (orange) highlights diagnostic methods such as endoscopy and barium swallow. The regenerative medicine cluster has emerged recently, whereas other clusters, such as disease conditions and treatment methods, remain prominent. The research hotspots and time distributions of different clusters are shown in Figure 5B and C. Clusters involving regenerative medicine and tissue engineering have emerged as new fields in recent years, whereas the clusters related to diseases and conditions of esophageal stricture, methods for treating and preventing esophageal stricture, treatment populations, experimental subjects, and diagnostic and examination procedures for patients with esophageal stricture have remained hotspots.
Keyword trends over time reveal important insights (Figure 5D). Recent research hotspots include “postoperative stricture”, “stent placement”, and “chemoradiotherapy”. Earlier trends focused on “photodynamic therapy” and “omeprazole”, with more topics such as “Barrett’s esophagus” and “adenocarcinoma” emerging from 2007-2014. From 2015 onward, areas such as “postoperative stricture” and “balloon dilatation” gained attention. New topics such as “cell sheets” and “ESD” are now emerging. The analysis indicates ongoing interest in clinical treatments, including “stent placement” and “chemoradiotherapy”, as well as a sustained focus on esophageal cancers and treatment efficacy.
Bibliometric analysis is a valuable tool for assessing global research trends and hotspots across various disciplines[25,26]. Our study analyzed 1485 articles on esophageal stricture from the WoSCC database published over the past two decades. The results indicated a steady increase in publications from 2004 to 2009, followed by a significant surge in 2010, likely attributed to the adoption of endoscopic mucosal resection and ESD for early esophageal tumors[27]. These innovations highlight the incidence and management of postoperative esophageal strictures, which remain pivotal for future clinical practice and research. Despite annual fluctuations, the number of publications has shown a general upward trend. The United States leads in publications, citations, and collaborations, reflecting its robust health care infrastructure and academic resources. Similarly, China and Japan exhibit high research activity, driven by their large patient populations and aging demographics, respectively. Key journals such as Diseases of the Esophagus and Surgical Endoscopy focus on esophageal diseases, with significant citation networks emphasizing the role of endoscopic techniques. However, interdisciplinary collaborations remain limited, highlighting an area for growth. Influential researchers and institutions, such as Song HY in South Korea[28-30] and Yamato M in Japan[31-33], have pioneered innovations in esophageal stricture treatment. Their work spans endoscopic techniques, tissue engineering, and regenerative medicine, demonstrating the benefits of interdisciplinary collaboration. The diverse research focuses in the United States and Japan-ranging from Barrett’s esophagus to ESD and tissue engineering-underscore regional differences in addressing esophageal strictures. These efforts collectively advance the understanding and management of this complex condition[18,34-37]. The top 10 most-cited references globally illustrate the diversity of the research landscape concerning esophageal stricture, encompassing various diagnostic and therapeutic techniques. These include methods for evaluation and treatment methods such as endoscopic techniques (e.g., radiofrequency ablation), classification systems for specific diseases (e.g., eosinophilic esophagitis), and advancements in tissue engineering and cell therapy. A noticeable divergence exists between the research focuses of the United States and Japan. Research in the United States has focused primarily on the evaluation and treatment of Barrett’s esophagus and GERD[16], whereas Japan has emphasized ESD and tissue engineering therapies[18]. Endoscopic technology plays a crucial role in diagnosing and treating esophageal stricture. Endoscopic technology is pivotal in both diagnosing and treating esophageal stricture, and endoscopy-related research constitutes a substantial portion of the highly cited articles in both countries.
Esophageal stricture research addresses a variety of causes, including congenital anomalies, GERD, esophagitis, tuberculosis, and tumors, with a focus on prevention and treatment. This complexity arises from the multifactorial nature of the disease, which involves congenital defects, chronic inflammation, infections, and tumors. Congenital anomalies such as esophageal atresia and tracheoesophageal fistula often require early surgical intervention, but strictures may develop post-surgery, necessitating long-term monitoring. GERD, caused by acid reflux, is a leading cause of chronic esophageal inflammation, potentially resulting in stricture formation[38]. The global prevalence of GERD is estimated to be between 8% and 33%[39]. GERD is widespread in modern society, especially among young people, due to lifestyle changes, such as excessive intake of alcohol, coffee, chocolate, and high-fat foods or lying down immediately after meals, which can easily trigger GERD[40]. If severe GERD is not effectively treated over a long period, it may lead to esophageal stricture. Research has emphasized the effective management and treatment of GERD to prevent esophageal stricture, including the use of proton pump inhibitors and lifestyle changes to reduce stomach acid reflux[41]. Esophagitis, particularly inflammation of the esophageal tissue caused by corrosive chemicals or physical trauma, is another major cause of esophageal stricture[42,43]. Recurrent esophagitis can lead to fibrosis and stricture of the esophageal wall, which usually requires management through medication and endoscopic treatment methods[44]. Additionally, esophageal tuberculosis and esophageal tumors are essential causes of esophageal stricture, especially in developing countries. Esophageal strictures caused by tuberculosis require antituberculosis treatment and surgical intervention[45], whereas esophageal tumors typically require a combination of surgery, radiotherapy, and chemotherapy[46]. Given the diverse causes of esophageal stricture, treatment strategies must be comprehensive and tailored[47,48]. Common approaches include medication, endoscopic techniques, surgery, and stent placement. Medication, such as corticosteroids, is used for inflammatory causes. Endoscopic treatments such as balloon dilation and incision therapy have been shown to be effective in improving outcomes and reducing complications[49,50]. Surgical intervention is often necessary for severe cases, such as congenital defects or tumors, and multidisciplinary approaches enhance safety and efficacy[46]. In the past two decades, the use of esophageal stents has rapidly evolved from rigid plastic tubes to flexible self-expanding metal, plastic, and biodegradable stents. In the palliative treatment of malignant dysphagia, both self-expanding metal and plastic can quickly and effectively alleviate symptoms. Randomized controlled trials have shown that plastic stents present more technical difficulties and late migration, making self-expanding metal more favored than plastic[51].
Esophageal stricture treatment methods are continuously evolving, with numerous new technologies and therapies being research. These include endoscopic drug injection, antifibrotic drugs, biodegradable stents, autologous tissue transplantation, and regenerative medicine. Endoscopic drug injection delivers targeted medication to the stricture site, alleviating inflammation and fibrosis, with corticosteroids commonly used to suppress inflammation and prevent further fibrosis[52,53]. Self-expanding stents combined with steroids improve outcomes by keeping the stricture open and releasing drugs to reduce fibrosis[54]. These stents can keep the esophageal stricture site open. Moreover, the continuous release of drugs can reduce collagen synthesis and alleviate fibrosis and scar formation, thus achieving prolonged therapeutic effects. Experimental studies have also shown that injecting autologous esophageal epithelial cell suspensions can promote re-epithelialization and reduce fibrosis, thereby decreasing the severity of esophageal strictures after ESD[55]. Further research is needed to confirm its future clinical use. Antifibrotic drugs play crucial roles in treating esophageal strictures. By inhibiting the formation of fibrous tissue, these drugs can effectively prevent the worsening of esophageal strictures, thereby reducing patient suffering and improving quality of life[56]. These drugs work through various mechanisms, such as inhibiting collagen synthesis, reducing local inflammatory responses, and preventing the excessive proliferation of fibroblasts. They typically include steroids, anti-inflammatory drugs, and specially designed antifibrotic medications[57]. Compared with metal stents, biodegradable stents are advantageous because they reduce long-term complications and reinterventions, offering safer and more effective treatments for refractory esophageal strictures[58]. Autologous tissue transplantation, in which the patient’s tissue is used for repair, reduces the degree of rejection risk and enhances healing[59]. The use of acellular dermal matrix may also be as effective as autologous mucosal transplantation in preventing stricture formation after ESD. The core of this technique is to extract the required tissue from healthy parts of the patient’s body and then transplant it to damaged or repair-needed areas[60]. Regenerative medicine, which uses stem cells and tissue engineering, aims to restore damaged esophageal tissue. Stem cells, which are capable of differentiating into various cell types, promote the growth of healthy esophageal tissue when transplanted[61]. Tissue engineering technologies, such as biological scaffolds, support cell attachment and growth[62]. Experiments have successfully constructed esophageal tissue via mesenchymal stem cells and scaffolds[63]. Biomaterials such as hydrogels have also shown promise in reducing stricture incidence after endoscopic procedures, promoting healing and reducing inflammation[64]. While these therapies are still in development, they offer hope for improving treatment outcomes and patient quality of life.
Our bibliometric analysis relies solely on specific databases, which may lead to the omission of important research from other databases. Additionally, the coverage and inclusion criteria of different databases vary, potentially affecting the comprehensiveness and representativeness of the results. Research often covers specific periods, ignoring earlier or more recent research developments, which may result in a biased understanding of research trends. Bibliometric analysis relies mainly on quantitative indicators such as citation counts, which may not fully reflect the actual impact and quality of the research. For example, a high citation rate may be due to negative reviews or controversial content. Most databases prioritize the inclusion of English literature, which may lead to the underestimation or neglect of relevant research from non-English-speaking countries and regions.
With the advancement of more clinical studies and continuous technological improvements, the treatment of esophageal stricture will become more precise and personalized, resulting in more significant benefits to patients. The development of esophageal stricture research indicates that this field is vibrant and ever-expanding. Progress in regenerative medicine and tissue engineering is expected to achieve breakthroughs in the future, while the continuous development of endoscopic and pharmaceutical treatments ensures the improvement of patient care. Clinical trials and meta-analyses have strengthened evidence-based medicine, enhancing the reliability of treatment methods. Researchers consistently focus on patient safety and treatment efficacy, highlighting their comprehensive approach to addressing this complex medical challenge.
The authors thank all the researchers whose study included in our analysis.
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