ABSTRACT
Objective Explore the differences in effectiveness and safety between endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early esophageal cancer (EEC).Methods Papers published from January 1990 to December 2012 in Medline,Embase,Cochrane library,Wanfang,VIP and CNKI were searched in English and Chinese respectively to identify the studies comparing ESD with EMR for EEC.Meta-analysis for each outcome of the included studies that were identified by the inclusion criteria and the exclusion criteria was conducted using software Revman 5.1.Outcome measures consisted of three effectiveness-relevant measures (rates of en bloc resection,curative resection,local recurrence) and four safety-relevant measures (bleeding,perforation,stenosis and operation time).Results A total of 8 non-randomized retrospective cohort studies (five full-text and three abstracts) were included.Meta-analysis showed significantly higher rates of en bloc resection [98.36％ (360/366) vs.41.79％ (252/603),P ＜ 0.01],curative resection [90.81％ (168/185) vs.50.65 ％ (194/383),P ＜ 0.01] and perforation [4.51％ (21/466) vs.1.25％ (8/640),P =0.03] in ESD group compared with EMR group,and the rate of local recurrence was significantly lower in ESD group [0.55％ (2/366) vs.13.76％ (83/603),P ＜0.01].There were no significant differences in the rates of bleeding [0.21％ (1/466) vs.0.63％(4/640),P =0.41] or stenosis [10.48％ (39/372) vs.10.15％ (41/404),P =0.89].Conclusion Compared with EMR,ESD showed obvious advantages of effectiveness and resemble risks for endoscopic resection of EEC,therefore ESD should be the first choice for endoscopic treatment of EEC.
ABSTRACT
Objective To compare the diagnostic efficacies of narrow-band imaging (NBI) in distinguishing neoplastic from non-neoplastic colorectal lesions with routine endoscopy and with magnifying endoscopy. Methods Patients with colorectal lesions detected by NBI from September 2008 to February 2010 were enrolled in the study. These lesions were classified by pit pattern and capillary pattern, which was then assessed by reference to histopathology. Results A total of 100 patients with colorectal lesions were enrolled, and the lesions were observed by NBI with ordinary endoscopy (n =64) and NBI with magnifying endoscopy (n =36), respectively, and 7 cases (5 in NBI with ordinary endoscopy and 2 in NBI with magnifying endoscopy) which did not meet the diagnostic criteria were excluded. The overall diagnostic accuracy of NBI endoscopy in distinguishing neoplastic from non-neoplastic colorectal lesions was 91.4% ( 85/93 ), in which NBI with ordinary endoscopy and magnifying endoscopy was 89. 8% (53/59) and 94. 1% (32/34),respectively, with both significantly higher than that of conventional colonoscopy reported in the literature (79. 1% ) (P ＜ 0. 05 ). However, no significant difference was detected between 2 methods ( P ＞ 0. 05 ).Conclusion Similar with NBI magnifying endoscopy, NBI endoscopy without high magnification may also be useful to distinguish neoplastic from non-neoplastic colorectal lesions.