CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(08): E998-E1007
DOI: 10.1055/a-0579-9050
Review
Owner and Copyright © Georg Thieme Verlag KG 2018

ESD versus EMR in non-ampullary superficial duodenal tumors: a systematic review and meta-analysis

Enrique Pérez-Cuadrado-Robles
1  Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
,
Lucille Quénéhervé
2  Institut des Maladies de l’Appareil digestif, University Hospital of Nantes, France
,
Walter Margos
1  Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
,
Tom G. Moreels
1  Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
,
Ralph Yeung
1  Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
,
Hubert Piessevaux
1  Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
,
Emmanuel Coron
2  Institut des Maladies de l’Appareil digestif, University Hospital of Nantes, France
,
Anne Jouret-Mourin
3  Department of Pathology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
,
Pierre H. Deprez
1  Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
› Author Affiliations
Further Information

Publication History

submitted 19 September 2017

accepted after revision 02 February 2018

Publication Date:
03 August 2018 (online)

Abstract

Background and study aims Endoscopic submucosal dissection (ESD) has been developed as an option for treatment of esophageal, gastric and colorectal lesions. However, there is no consensus on the role of ESD in duodenal tumors.

Methods This systematic review and meta-analysis compared ESD and endoscopic mucosal resection (EMR) in sporadic non-ampullary superficial duodenal tumors (NASDTs), including local experience. We conducted a search in PubMed, Scopus and the Cochrane library up to August 2017 to identify studies that compared both techniques reporting at least one main outcome (en-bloc/complete resection, local recurrence). Pooled outcomes were calculated under fixed and random-effect models. Subgroup analyses were conducted.

Results A total of 753 patients presenting with 784 NASDTs (242 ESD, 542 EMR) in 14 studies were included. Tumor size (MD: 5.88, [CI95 %: 2.15, 9.62], P = 0.002, I2 = 79 %) and procedure time (MD: 65.65, [CI95 %: 40.39, 90.92], P < 0.00001, I2 = 88 %) were greater in the ESD group. En-bloc resection rate was significantly higher in Asian studies (OR: 2.16 [CI95 %: 1.15, 4.08], P = 0.02, I2: 46 %). ESD provided a higher complete resection rate (OR: 1.63 [I95 %: 1.06, 2.50], P = 0.03, I2: 59 %), but there was no risk difference in the risk of local recurrence (RD: – 0.03 [CI95 %: – 0.07, 0.01], P = 0.15, I2: 0 %) or delayed bleeding. ESD was associated with an increased number of intraoperative perforations [RD: 0.12 (CI95 %: 0.04, 0.20), P = 0.002, I2: 56 %] and emergency surgery for delayed perforations. The inclusion of eligible studies was limited to retrospective series with inequalities in comparative groups.

Conclusions Duodenal ESD for NASDTs may achieve higher en-bloc and complete resections at the expense of a greater perforation rate compared to EMR. The impact on local recurrence remains uncertain.