Endoscopic submucosal dissection for locally recurrent gastric neoplasia following endoscopic resection: a systematic review and meta-analysis.
Tareq Alsaleh, Hamza Akram, Syed Hasaan Rahman et al.
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In 30 seconds
This systematic review and random-effects meta-analysis assessed salvage endoscopic submucosal dissection (ESD) for locally recurrent gastric neoplasia at or near a prior endoscopic resection scar, where fibrosis can make treatment technically challenging. Seven studies included 259 patients and 265 ESD procedures. Across five studies, pooled curative resection was 69.7% (95% CI, 60.6-78.1), and 8.2% (95% CI, 3.3-14.6) required surgery. En bloc and R0 resection rates were high, while local recurrence and reported adverse events were relatively low.
Key findings
- Pooled curative resection was 69.7% (95% CI, 60.6-78.1; I 2 = 38%) across 5 studies and 243 ESDs.
- Surgery was required in 8.2% (95% CI, 3.3-14.6; I 2 = 38.4%).
- Pooled en bloc and R0 resection rates were 92.3% (95% CI, 79.1-99.7) and 87.5% (95% CI, 82.1-92.2), respectively.
- Over a mean follow-up of 42 months, local recurrence was 2.0% (95% CI, 0.0-9.7); delayed bleeding and perforation were each 4.1%.
Why it matters
Recurrent lesions at a previous resection scar can be difficult to treat because of submucosal fibrosis. These pooled results suggest salvage ESD can achieve organ-preserving resection in many cases, with relatively low reported recurrence and morbidity. The findings help frame its potential role while underscoring that curative resection is not assured and some patients require surgery.
What to keep in mind
The evidence comprised seven studies, and estimates showed substantial heterogeneity for some outcomes, including en bloc resection and local recurrence.