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Endoscopic submucosal dissection vs. endoscopic mucosal resection in the treatment of early Barrett's neoplasia: Systematic review and meta-analysis.
Gallegos, Megui Marilia Mansilla; Gomes, Igor Logetto Caetité; Brunaldi, Vitor Ottoboni; Bestetti, Alexandre Moraes; Marques, Sergio Barbosa; Miyajima, Nelson Tomio; Filho, Hiram Menezes Nascimento; da Silva, Pedro Henrique Veras Ayres; Kum, Angelo So Taa; Bernardo, Wanderley Marques; de Moura, Eduardo Guimarães Hourneaux.
Afiliação
  • Gallegos MMM; Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
  • Gomes ILC; Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
  • Brunaldi VO; Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
  • Bestetti AM; Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
  • Marques SB; Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
  • Miyajima NT; Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
  • Filho HMN; Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
  • da Silva PHVA; Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
  • Kum AST; Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
  • Bernardo WM; Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
  • de Moura EGH; Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
Dig Endosc ; 2024 Sep 02.
Article em En | MEDLINE | ID: mdl-39219530
ABSTRACT

OBJECTIVES:

Endoscopic resection is the preferred approach to treat early Barrett's neoplasia, reducing the need for surgical interventions. However, the best choice between endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) remains unclear. The study aimed to compare the efficacy and safety of EMR vs. ESD for early Barrett's neoplasia.

METHODS:

An electronic search was conducted in MEDLINE, Central Cochrane, EMBASE, and LILACS until November 2023. Studies comparing ESD vs. EMR in the treatment of patients with early Barrett's neoplasia were included. This study was performed according to the Preferred Report Items for Systematic Reviews and Meta-Analyses guidelines. The ROBIN-I tool was used to analyze the risk of bias and GRADE to measure the quality of the evidence.

RESULTS:

A total of 9352 patients from 15 observational studies were included. Patients undergoing ESD had significantly higher rates of en-bloc (odds ratio [OR] 25.96, 95% confidence interval [CI] 13.82, 48.74; I2 = 52%; P < 0.00001) and R0 (OR 5.10, 95% CI 3.29, 7.91; I2 = 73%; P < 0.00001) with a higher risk of adverse events, including bleeding, stricture formation, and perforation. In a subgroup analysis of patients who did not receive radiofrequency ablation, ESD had a lower recurrence rate than EMR (OR 0.22, 95% CI 0.05, 0.94; I2 = 88%; P = 0.04).

CONCLUSION:

Endoscopic submucosal dissection is more effective than EMR in treating early Barrett's neoplasia at the expense of higher adverse events rates.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Dig Endosc Assunto da revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Austrália
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Dig Endosc Assunto da revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Austrália