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Endoscopy
DOI: 10.1055/a-2357-6111
Systematic review

Endoscopic submucosal dissection and endoscopic mucosal resection for Barrett’s-associated neoplasia: a systematic review and meta-analysis of the published literature

Dhruvil Radadiya 
1   Gastroenterology, University of Kansas School of Medicine, Kansas City, United States (Ringgold ID: RIN12251)
,
Madhav Desai
2   Gastroenterology, University of Minnesota Medical Center, Minneapolis, United States (Ringgold ID: RIN14400)
3   Gastroenterology and Hepatology, The University of Texas Health Science Center at Houston, Houston, United States (Ringgold ID: RIN12340)
,
Harsh Patel
1   Gastroenterology, University of Kansas School of Medicine, Kansas City, United States (Ringgold ID: RIN12251)
,
Jena Velji-Ibrahim
4   Internal Medicine, University of South Carolina School of Medicine, Greenville, United States (Ringgold ID: RIN12322)
,
Marco Spadaccini
5   Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy (Ringgold ID: RIN551905)
,
Sachin Srinivasan
1   Gastroenterology, University of Kansas School of Medicine, Kansas City, United States (Ringgold ID: RIN12251)
,
Shruti Khurana
1   Gastroenterology, University of Kansas School of Medicine, Kansas City, United States (Ringgold ID: RIN12251)
,
Viveksandeep Thoguluva Chandrasekar 
6   Gastroenterology, Augusta University, Augusta, United States (Ringgold ID: RIN1421)
,
Abhilash Perisetti 
7   Gastroenterology, Kansas City VA Medical Center, Kansas City, United States (Ringgold ID: RIN20044)
,
Alessandro Repici
5   Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy (Ringgold ID: RIN551905)
8   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy (Ringgold ID: RIN437807)
,
Cesare Hassan
5   Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy (Ringgold ID: RIN551905)
,
Prateek Sharma
1   Gastroenterology, University of Kansas School of Medicine, Kansas City, United States (Ringgold ID: RIN12251)
7   Gastroenterology, Kansas City VA Medical Center, Kansas City, United States (Ringgold ID: RIN20044)
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Abstract

Background The role of endoscopic submucosal dissection (ESD) in the treatment of Barrett esophagus-associated neoplasia (BEN) has been evolving. We examined the efficacy and safety of ESD and endoscopic mucosal resection (EMR) for BEN.

Methods A database search was performed for studies reporting efficacy and safety outcomes of ESD and EMR for BEN. Pooled proportional and comparative meta-analyses were performed.

Results 47 studies (23 ESD, 19 EMR, 5 comparative) were included. The mean lesion sizes for ESD and EMR were 22.5 mm and 15.8 mm, respectively; most lesions were Paris type IIa. For ESD, pooled analysis showed rates of en bloc, R0, and curative resection, and local recurrence of 98%, 78%, 65%, and 2%, respectively. Complete eradication of dysplasia and intestinal metaplasia were achieved in 94% and 59% of cases, respectively. Pooled rates of perforation, intraprocedural bleeding, delayed bleeding, and stricture were 1%, 1%, 2%, and 10%, respectively. For EMR, pooled analysis showed rates of en bloc, R0, and curative resection, and local recurrence of 37%, 67%, 62%, and 6%, respectively. Complete eradication of dysplasia and intestinal metaplasia were achieved in 94% and 75% of cases. Pooled rates of perforation, intraprocedural bleeding, delayed bleeding, and stricture were 0.1%, 1%, 0.4%, and 8%, respectively. The mean procedure times for ESD and EMR were 113 and 22 minutes, respectively. Comparative analysis showed higher en bloc and R0 resection rates with ESD compared with EMR, with comparable adverse events.

Conclusion ESD and EMR can both be employed to treat BEN depending on lesion type and size, and center expertise.

Supplementary Material



Publication History

Received: 21 September 2023

Accepted after revision: 28 June 2024

Accepted Manuscript online:
28 June 2024

Article published online:
09 September 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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