The Korean Society of Gastroenterology & SIDDS 2064 : Slide Session ; K-UG-16 : Upper GI Tract ; Endoscopic Submucosal Dissection of Gastric Subepithelial Tumors: A Systematic Review and Meta- Analysis = The Korean Society of Gastroenterology & SIDDS 2064 : Slide Session ; K-UG-16 : Upper GI Tract ; Endoscopic Submucosal Dissection of Gastric Subepithelial Tumors: A Systematic Review and Meta- Analysis

다국어 초록 (Multilingual Abstract)

Background: The treatment of gastric subepithelial tumors (SETs) depends on surgical resection. The aim of this study was to evaluate the current evidence about therapeutic outcomes of endoscopic submucosal dissection (ESD) technique for the treatment of gastric SET. Methods: A systematic literature review was conducted using the core databases. Data about complete resection rate and procedure-related perforation rate were extracted and analyzed. A random effect model was applied. The methodological quality of the enrolled studies was assessed by the Newcastle-Ottawa Scale. Sensitivity analyses were performed by the origin of the gastric wall layer of SETs. Publication bias was evaluated through the funnel plot, trim and fi ll method, Egger`s test, and rank correlation test. Results: A total of 290 SETs in 288 patients was enrolled from 9 studies (44 SETs originated from the submucosal layer, 246 SETs originated from the muscularis propria layer). The mean diameter of the lesions were ranged from 17.99 to 38mm (mean value). Overall, pooled complete resection rate was estimated as 86.2% (95%CI: 78.9%-91.3%, P< 0.001). If limited to the lesions originated from the submucosal layer, the pooled complete resection rate was 91.4% (95%CI: 77.9%-97%, P< 0.001). If limited to the lesions originated from the muscularis propria layer, the pooled complete resection rate was 84.4% (95%CI: 78.7%-88.8%, P< 0.001). Pooled procedure-related gastric perforation rate was 13% (95%CI: 9.4%-17.6%, P< 0.001). Among the 34 incomplete resected SETs, 20 cases were leiomyoma and 10 cases were GIST. Sensitivity analyses showed consistent results. Publication bias was not detected. Conclusions: In this analysis, ESD including endoscopic muscularis dissection is technically feasible procedure for the treatment of SETs. However, selection bias is suspected from the enrolled studies. For the development of proper indication about ESD for SETs, further studies are needed.