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Endoscopic resection of esophageal and gastric submucosal tumors from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation: A systematic review and meta-analysis

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Abstract

Background

Submucosal tunneling endoscopic resection (STER) and endoscopic submucosal excavation (ESE) are less-invasive therapeutic alternatives to surgical resection for the removal of esophageal or gastric submucosal tumors (SMTs). This study aimed to comparing STER versus ESE for the resection of esophageal and gastric SMTs from the muscularis propria.

Methods

This systematic review and meta-analysis was reported in accordance with PRISMA guidelines through December 2020. Pooled outcome measures included complete resection, en bloc resection, bleeding, perforation, adverse events, recurrence, procedure duration, and length of hospital stay. Risk ratio (RR) and mean difference (MD) was calculated as well as Peto time-to-event analyses to determine recurrence rate.

Results

Five retrospective cohort studies (n = 269 STER versus n = 319 ESE) were included. There was no difference in rates of complete resection [RR: 1.01 (95% CI 0.94, 1.07)], en bloc resection [RR: 0.95 (95% CI 0.84, 1.08)], recurrence [OR: 1.18 (95% CI 0.33, 4.16)], and total adverse events [RR: 1.33 (95% CI 0.78, 2.27)]. Specific adverse events including rates of perforation [RR: 0.57 (95% CI 0.12, 2.74)] and bleeding [RR: 1.21 (95% CI 0.30, 4.88)] were not different between STER and ESE. There was a statistical difference when evaluating procedure time, with the STER group presenting significantly larger values [MD: 24.62 min (95% CI 20.04, 29.20)].

Conclusion

STER and ESE were associated with similar efficacy and safety; however, ESE was associated with a significantly decreased time to complete the procedure.

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Authors and Affiliations

  1. Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Fernando Lopes Ponte Neto, Diogo Turiani Hourneaux de Moura, Vitor Massaro Takamatsu Sagae, Igor Braga Ribeiro, Fabio Catache Mancini, Mateus Bond Boghossian, Nelson Tomio Miyajima, Edson Ide, Wanderley Marques Bernardo & Eduardo Guimarães Hourneaux de Moura

  2. Division of Gasteoenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA

    Thomas R. McCarty

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  1. Fernando Lopes Ponte Neto
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Contributions

FLPN: acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; DTHM: analysis and interpretation of data, revising the article; FCM: analysis and interpretation of data, revising the article; VMTS: acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; IBR: analysis and interpretation of data, revising the article; MBB: analysis and interpretation of data, revising the article; TRM: analysis and interpretation of data, revising the article; NTM: analysis and interpretation of data, revising the article; Ide, E:, revising the article and english; WMB: analysis and interpretation of data, drafting the article, final approval; EGHM analysis and interpretation of data, drafting the article, revising the article, final approval.

Corresponding author

Correspondence to Igor Braga Ribeiro.

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Disclosures

Fernando Lopes Ponte Neto, Diogo Turiani Hourneaux de Moura, Vitor Massaro Takamatsu Sagae, Igor Braga Ribeiro, Fabio Catache Mancini, Mateus Bond Boghossian, Thomas R. McCarty, Nelson Tomio Miyajima, Edson Ide, and Wanderley Marques Bernardo declare that they have no conflict of interest. Dr. Eduardo Guimarães Hourneaux de Moura reports personal fees from Boston Scientific and Olympus but these were not relevant to this manuscript.

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The study was approved by the Research Ethics Committee of the University of São Paulo School of Medicine Hospital das Clínicas.

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Ponte Neto, F.L., de Moura, D.T.H., Sagae, V.M.T. et al. Endoscopic resection of esophageal and gastric submucosal tumors from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation: A systematic review and meta-analysis. Surg Endosc 35, 6413–6426 (2021). https://doi.org/10.1007/s00464-021-08659-9

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