Outcome of endoscopic submucosal dissection for early gastric cancer of conventional and expanded indications: Systematic review and meta-analysis

ObjectiveCurrent guidelines for treating early gastric cancer (EGC) with endoscopic submucosal dissection (ESD) are being developed with broader criteria. This systematic review and meta-analysis aimed to assess the application of expanded indications (EIN) by comparing outcomes between conventional indication (CIN) and EIN groups. MethodsLiterature databases were searched. Short-term outcomes, including endoscopic resection rates, complications and local recurrence, and long-term outcomes including gastric cancer-specific mortality and overall mortality were compared in the two groups. ResultsIn all, 13 studies were identified and evaluated. The EIN group had lower rates of en bloc (93.6% vs 97.0%, P<0.0001), complete (87.8% vs 95.8%, P<0.00001) and curative resection (82.4% vs 94.0%, P<0.00001) than the CIN group. The rates of delayed bleeding and perforation were both significantly higher in the EIN group (3.9% vs 2.8%, P=0.04 and 3.9% vs 1.8%, P<0.0001). Local recurrence rates were 0.6% in the CIN group and 1.5% in the EIN group (P=0.03). There were no significant differences between the two groups in the gastric-cancer specific mortality (P=0.22) and the overall mortality (P=0.37). ConclusionsLong-term mortality in the EIN group did not significantly differ from those in the CIN group, although the EIN group was associated with more unfavorable short-term outcomes. Thus, ESD could be recommended as an effective therapy for EGC of EIN.