Year 2021 / Volume 113 / Number 1
Review
Efficacy and safety of submucosal tunneling endoscopic resection for gastric submucosal tumors: a systematic review and meta-analysis

52-59

DOI: 10.17235/reed.2020.6989/2020

BenDaXin Cao, JiaXi Lu, YuYong Tan, DeLiang Liu,

Abstract
Introduction: submucosal tunneling endoscopic resection (STER) can be an effective treatment for submucosal tumors (SMTs) in the esophagus and cardia. However, STER may be more difficult to perform in the stomach than in the esophagus due to special anatomical and physiological features. The feasibility of STER to remove gastric STMs has not been systematically investigated. Therefore, this meta-analysis aimed to evaluate the safety and efficacy of STER for gastric SMTs. Material and methods: a comprehensive literature search of the Medline, Embase, PubMed, and Cochrane Library databases was conducted. Complete resection and en-bloc resection rates were considered as the primary outcome measures. The secondary outcome measure was the pooled estimate of complications. Results: nine studies including 301 patients with 305 lesions were finally included. The pooled estimate of en-bloc resections was 95.1 % (95 % CI: 88.9-97.9 %), Cochran’s Q-test, p = 0.151, and the weighted pooled rate (WPR) for complete resection was 97.9 % (95 % CI: 93.6-99.3 %), Cochran’s Q-test, p = 0.778. In addition, the pooled estimate of gas-related complications was 8.7 % (95 % CI: 4.6-15.9 %), Cochran’s Q-test, p = 0.057. The pooled estimate for mucosal laceration was 4.2 % (95 % CI: 2.2-7.9 %), Cochran’s Q-test, p = 0.572. The pooled estimate for delayed bleeding was 2.1 % (95 % CI: 0.9-4.8 %), Cochran’s Q-test, p = 0.985. The pooled estimate of inflammation-related complications was 8.6 % (95 % CI: 5.2-13.9 %), Cochran’s Q-test, p = 0.308. Conclusion: STER is an effective and safe technique for removing gastric SMTs with low complications, and complications, when encountered, can be treated conservatively.
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References
Uncategorized References
1. Moon JS. Role of Endoscopic Ultrasonography in Guiding Treatment Plans for Upper Gastrointestinal Subepithelial Tumors. Clin Endosc. 2016 May;49(3):220-5.
2. Sakamoto H, Kitano M, Kudo M. Diagnosis of subepithelial tumors in the upper gastrointestinal tract by endoscopic ultrasonography. World J Radiol. 2010;2(8):289-97.
3. Ponsaing L-G, Kiss K, Hansen M-B. Classification of submucosal tumors in the gastrointestinal tract. World J Gastroenterol. 2007;13(24):3311-5.
4. Lee IL, Lin PY, Tung SY, et al. Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer. Endoscopy. 2006;38(10):1024-8.
5. Nickl NJ, Wackerbarth S, Gress F, et al. 4590 Management of hypoechoic intramural tumors: a decision tree analysis of eus-directed vs. surgical management. Gastrointestinal Endoscopy. 2000;51(4):AB176.
6. Nishida T, Kawai N, Yamaguchi S, et al. Submucosal tumors: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors. Dig Endosc. 2013;25(5):479-89.
7. Tan Y, Tan L, Lu J, et al. Endoscopic resection of gastric gastrointestinal stromal tumors. Transl Gastroenterol Hepatol. 2017;2:115.
8. Shoji Y, Takeuchi H, Goto O, et al. Optimal minimally invasive surgical procedure for gastric submucosal tumors. Gastric Cancer. 2018;21(3):508-15.
9. Kim GH. Endoscopic resection of subepithelial tumors. Clin Endosc. 2012;45(3):240-4.
10. De Vogelaere K, Hoorens A, Haentjens P, et al. Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach. Surgical endoscopy. 2013;27(5):1546-54.
11. Song S, Feng M, Zhou H, et al. Submucosal tunneling endoscopic resection for large and irregular submucosal tumors originating from muscularis propria layer in upper gastrointestinal tract. Journal of Laparoendoscopic and Advanced Surgical Techniques. 2018;28(11):1364-70.
12. Jain D, Desai A, Mahmood E, et al. Submucosal tunneling endoscopic resection of upper gastrointestinal tract tumors arising from muscularis propria. Ann Gastroenterol. 2017;30(3):262-72.
13. Peng W, Tan S, Huang S, et al. Efficacy and safety of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors with more than 1-year' follow-up: a systematic review and meta-analysis. Scand J Gastroenterol. 2019;54(4):397-406.
14. Zhang X, Modayil R, Criscitelli T, et al. Endoscopic resection for subepithelial lesions-pure endoscopic full-thickness resection and submucosal tunneling endoscopic resection. Transl Gastroenterol Hepatol. 2019;4:39.
15. Inoue H, Ikeda H, Hosoya T, et al. Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy. 2012;44(3):225-30.
16. Lu J, Jiao T, Li Y, et al. Heading toward the right direction--solution package for endoscopic submucosal tunneling resection in the stomach. PLoS One. 2015;10(3):e0119870-e.
17. Tan Y, Zhou B, Zhang S, et al. Submucosal Tunneling Endoscopic Resection for Gastric Submucosal Tumors: a Comparison Between Cardia and Non-cardia Location. J Gastrointest Surg. 2019;23(11):2129-35.
18. Du C, Chai N, Linghu E, et al. Treatment of cardial submucosal tumors originating from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation. Surgical Endoscopy. 2018;32(11):4543-51.
19. Duan T-Y, Tan Y-Y, Wang X-H, et al. A comparison of submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric fundus submucosal tumors. Rev Esp Enferm Dig. 2018;110(3):160-5.
20. Tan Y, Tang X, Guo T, et al. Comparison between submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric stromal tumors originating from the muscularis propria layer. Surgical endoscopy. 2017;31(8):3376-82.
21. Mao XL, Ye LP, Zheng HH, et al. Submucosal tunneling endoscopic resection using methylene-blue guidance for cardial subepithelial tumors originating from the muscularis propria layer. Dis Esophagus. 2017;30(4):1-7.
22. Zhang Q, Wang F, Wei G, et al. Endoscopic resection of gastric submucosal tumors: A comparison of endoscopic nontunneling with tunneling resection and a systematic review. Saudi J Gastroenterol. 2017 Jan-Feb;23(1):52-9.
23. Li Q-L, Chen W-F, Zhang C, et al. Clinical impact of submucosal tunneling endoscopic resection for the treatment of gastric submucosal tumors originating from the muscularis propria layer (with video). Surgical endoscopy. 2015;29(12):3640-6.
24. Xu M-d, Lu W, Li Q-l, et al. Application and evaluation of submucosal tunneling endoscopic resection of gastric submucosal tumors originating from the muscularis propria layer. Zhonghua Wei Chang Wai Ke Za Zhi. 2012;15(7):671-4.
25. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.
26. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603-5.
27. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539-58.
28. Wallace BC, Schmid CH, Lau J, et al. Meta-Analyst: software for meta-analysis of binary, continuous and diagnostic data. BMC Med Res Methodol. 2009;9:80.
29. Xu H-W, Zhao Q, Yu S-X, et al. Comparison of different endoscopic resection techniques for submucosal tumors originating from muscularis propria at the esophagogastric junction. BMC Gastroenterol. 2019;19(1):174-.
30. Liu B-R, Song J-T. Submucosal Tunneling Endoscopic Resection (STER) and Other Novel Applications of Submucosal Tunneling in Humans. Gastrointest Endosc Clin N Am. 2016;26(2):271-82.
31. Lv X-H, Wang C-H, Xie Y. Efficacy and safety of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors: a systematic review and meta-analysis. Surgical endoscopy. 2017;31(1):49-63.
32. Zhang Q, Cai J-Q, Xiang L, et al. Modified submucosal tunneling endoscopic resection for submucosal tumors in the esophagus and gastric fundus near the cardia. Endoscopy. 2017;49(8):784-91.
33. Zhang Q, Li Y, Meng Y, et al. Should the Integrity of Mucosa Be Considered in Endoscopic Resection of Gastric Submucosal Tumors? Gastroenterology. 2016;150(4).
34. Li Y, Zhang Q, Zhu C, et al. Endoscopic mucosa-sparing lateral dissection for treatment of gastric submucosal tumors: a prospective cohort study. Endoscopy. 2018;50(9):886-90.
35. Zhang Q, Li Y, Lian Z-Y, et al. A modified endoscopic method for resection of gastric submucosal tumor. Surgical endoscopy. 2018;32(1):536-43.
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Cao B, Lu J, Tan Y, Liu D. Efficacy and safety of submucosal tunneling endoscopic resection for gastric submucosal tumors: a systematic review and meta-analysis. 6989/2020


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Publication history

Received: 18/02/2020

Accepted: 24/06/2020

Online First: 23/11/2020

Published: 11/01/2021

Article revision time: 124 days

Article Online First time: 279 days

Article editing time: 328 days


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