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Endoscopy 2020; 52(05): 338-348
DOI: 10.1055/a-1106-3761
Systematic review

Efficacy and safety of traction-assisted endoscopic submucosal dissection: a meta-regression of randomized clinical trials

Ying-Fong Su‡   *
1   School of Medicine, College of Medicine, Taipei Medical University, Taipei, Republic of China (Taiwan)
2   Department of Education, Taipei Medical University Hospital, Taipei, Republic of China (Taiwan)
,
Sheng-Wei Cheng‡   *
3   Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Republic of China (Taiwan)
,
Chun Chao Chang
4   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Republic of China (Taiwan)
5   Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Republic of China (Taiwan)
,
Yi-No Kang
6   Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Republic of China (Taiwan)
7   Evidence-Based Medicine Center and Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Republic of China (Taiwan)
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Traction is most important for the widespread use of endoscopic submucosal dissection, especially in procedures presenting particular difficultyEndoscopy 2020; 52(05): 328-329
DOI: 10.1055/a-1143-5959

Abstract

Background Endoscopic submucosal dissection (ESD) is widely used to treat gastrointestinal lesions. A traction-assisted (TA) strategy has been recently developed for ESD. In this study, we evaluated the safety and efficacy of TA-ESD compared with conventional ESD (C-ESD).

Methods We searched PubMed, Embase, Web of Science, and the China National Knowledge Infrastructure to identify randomized clinical trials that compared TA-ESD and C-ESD. No filters for language or date of publication were used. Outcomes included complete resection rate, resected specimen size, procedure time, hemostasis usage (frequency), overall complication rate, perforation rate, and delayed bleeding rate. We used the mean difference (MD) for continuous outcomes in a random-effects model and Peto odds ratio (POR) for binary outcomes where any zero cell existed. Effect sizes and their 95 % confidence intervals (CIs) were determined.

Results 12 out of 929 identified articles, including 1499 patients, were analyzed. According to pooled results, TA-ESD produced similar R0 resections to C-ESD, but its procedure time (minutes) was shorter than that of C-ESD (MD – 16.02, 95 %CI – 22.71 to – 9.33). Moreover, TA-ESD had a lower complication rate (POR 0.47, 95 %CI 0.29 to 0.76) and perforation rate (POR 0.24, 95 %CI 0.10 to 0.56) than C-ESD. A nonsignificant difference in delayed bleeding rate was observed, although there was a trend toward this being lower in TA-ESD than C-ESD (POR 0.90, 95 %CI 0.46 to 1.75, I 2 = 12 %).

Conclusions The traction-assisted strategy improves safety and efficacy in the treatment of patients with ESD. However, we observed different effect sizes in the esophagus, stomach, and colorectum.

* Equal first authors


Appendix 1s, Fig. 1s – 7s, Table 1s



Publication History

Received: 30 September 2019

Accepted: 04 January 2020

Article published online:
28 February 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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