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 95â% 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 -â16.02, 95â%CI -â22.71 to -â9.33). Moreover, TA-ESD had a lower complication rate (POR 0.47, 95â%CI 0.29 to 0.76) and perforation rate (POR 0.24, 95â%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, 95â%CI 0.46 to 1.75, I 2â=â12â%). 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.
Subject(s)
Endoscopic Mucosal Resection , China , Dissection , Endoscopic Mucosal Resection/adverse effects , Humans , Randomized Controlled Trials as Topic , Traction , Treatment OutcomeABSTRACT
The purpose of this letter was to explore how lesion size affects the pooled effect of traction-assisted endoscopic submucosal dissection on procedure time. Our meta-regression showed that lesion size negatively associated with the effect of traction-assisted endoscopic submucosal dissection on procedure time (estimate point = - 1.02; 95% confidence interval, from - 1.58 to - 0.46). We also confirmed this result in different statistical models including fixed effect regression and two mixed effects regression models.
