Endoscopic Resection By Submucosal Tunneling Versus Endoscopic Excavation Of The Submucosa For Submucosal Of The Esophageal And Stomach Muscularis Propria – Systematic Review And Meta-Analysis

Aims Tumors of the submucosa (SMT) present as elevated lesions with intact mucosa. Until the emergence of safe endoscopic resection techniques, surgical resection was the main form of removal. This study aims to compare endoscopic submucosal tunneling (STER) and endoscopic submucosa (ESE) excavation for SMT resection of the muscle itself present in the esophagus and stomach, evaluating complete resection rates, en bloc resection rates, recurrence, perforation, complications, bleeding, procedure time and hospital stay.

Methods This study was carried out by the PRISMA guidelines and registered with PROSPERO. We searched electronically in databases (MEDLINE, EMBASE and Cochrane Library) until August 2020. We used ROBINS-I to assess the risk of bias. An analysis was performed using RevMan 5.4; Cochrane Collaboration, Oxford, UK. The quality of the evidence was analyzed using the GRADE.

Results Five studies were selected, after evaluating 3528 articles. Comparing 269 patients in the STER group and 319 in the ESE group. Only observational studies are included. There was no statistical difference between the groups when evaluated as complete resection rates(RD:0.00, 95 % CI:-0.05–0.06, p:0.89, I²:62 %), block resection(RD:-0.05, 95 % CI:-0.16–0.06, p:0.41, I²:57 %), recurrence(RD:0.00, 95 % CI:-0.02–0.03, p:0.82, I²:0 %), perforation(RD:0.00, 95 % CI:-0.02– 0.02, p:0.96, I²:0 %), complications(RD: 0.00, 95 % CI:-0.07–0.08, p:0.92, I²:0 %), bleeding(RD: 0.00, 95 % CI:-0.02–0, 02, p:0.91, I²:0 %) and hospital stay(MD:0.61, 95 % CI:-0.23– 1.45, p:0.15, I²:95 %). Evaluating the time of the procedure, it was necessary a longer time to perform STER (MD:24.62, 95 % CI:20.04–29.20, p < 0.00001, I²:38 %) ([Tab. 1]).

Tab. 1 Results of the main outcomes

Outcome	RD(risk difference)/MD (mean difference)	95 %CI	p (value indicating level of statistical significance)	Heterogeneity (I2 %)
Complete resection	0.00	-0.05–0.06	0.89	62
Perforation	0.00	-0.02– 0.02	0.96	0
Bleeding	0.00	-0.02– 0.02	0.91	0
Time	24.62	20.04–29.20	< 0.00001	38

Conclusions STER and ESE are safe and more widespread techniques for endoscopic resection of SMT of the muscularis propia in the esophagus and stomach. ESE tends to be performed in less time than the STER. The rates of complete resection, block resection, recurrence, perforation, complications, bleeding and hospital stay did not show any significant difference.

Citation Ponte Neto FL, Sagae VMT, Ribeiro IB et al. eP471 ENDOSCOPIC RESECTION BY SUBMUCOSAL TUNNELING VERSUS ENDOSCOPIC EXCAVATION OF THE SUBMUCOSA FOR SUBMUCOSAL OF THE ESOPHAGEAL AND STOMACH MUSCULARIS PROPRIA – SYSTEMATIC REVIEW AND META-ANALYSIS. Endoscopy 2021; 53: S252.

Publication History

Article published online:
19 March 2021