Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis
Background Endoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significantly decreased quality of life. Several therapies are performed to prevent this, but have not yet been compared in a syste...
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| Veröffentlicht in: | Surgical endoscopy 2016-07, Vol.30 (7), p.2779-2791 |
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| description | Background
Endoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significantly decreased quality of life. Several therapies are performed to prevent this, but have not yet been compared in a systematic review.
Methods
A systematic review of the literature and meta-analysis were performed using the MEDLINE, Embase, Cochrane, LILACS, Scopus, and CINAHL databases. Clinical trials and observational studies were searched from March 2014 to February 2015. Search terms included: endoscopy, ESD, esophageal stenosis, and esophageal stricture. Three retrospective and four prospective (three randomized) cohort studies were selected and involved 249 patients with superficial esophageal neoplasia who underwent ESD, at least two-thirds of the circumference. We grouped trials comparing different techniques to prevent esophagus stenosis post-ESD.
Results
We conducted different meta-analyses on randomized clinical trials (RCT), non-RCT, and global analysis. In RCT (three studies,
n
= 85), the preventive therapy decreased the risk of stenosis (risk difference = −0.36, 95 % CI −0.55 to −0.18,
P
= 0.0001). Two studies (one randomized and one non-randomized,
n
= 55) showed that preventative therapy lowered the average number of endoscopy dilatations (mean difference = −8.57, 95 % CI −13.88 to −3.25,
P
|
| doi_str_mv | 10.1007/s00464-015-4551-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1797870876</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1797870876</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-f5ea6d1b9218b74a79023781108e6a7fb618d4ab1863d36eab43fade3836132f3</originalsourceid><addsrcrecordid>eNp1kUtv1TAQhS0EopfCD2CDLLHpxuBX_GCHKgpIlWDRri0nmZRUSRw8Duj-e3yVghASq1nMd848DiEvBX8jOLdvkXNtNOOiYbppBPOPyEFoJZmUwj0mB-4VZ9J6fUaeId7zinvRPCVn0mhnhbcHsn7N8AOWMqaFpoECpvVbvIM4USx57MqWgcahQKaw9Am7tI4dxa2dty5hpfoREbqT_B2NFI9YYI6lMtV2hJ80Lj2doUQWlzgdccTn5MkQJ4QXD_Wc3F59uLn8xK6_fPx8-f6adcrKwoYGoulF6-slrdXRei6VdUJwBybaoTXC9Tq2whnVKwOx1WqIPSinjFByUOfkYvddc_q-AZYwj9jBNMUF0oZBWG-d5c6air7-B71PW6777pRprNCyUmKnupwQMwxhzeMc8zEIHk5xhD2OUOMIpziCr5pXD871Y9D_Ufz-fwXkDmBtLXeQ_xr9X9dfqq6Wsw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1797657142</pqid></control><display><type>article</type><title>Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Oliveira, J. F. ; Moura, E. G. H. ; Bernardo, W. M. ; Ide, E. ; Cheng, S. ; Sulbaran, M. ; Santos, C. M. L. ; Sakai, P.</creator><creatorcontrib>Oliveira, J. F. ; Moura, E. G. H. ; Bernardo, W. M. ; Ide, E. ; Cheng, S. ; Sulbaran, M. ; Santos, C. M. L. ; Sakai, P.</creatorcontrib><description>Background
Endoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significantly decreased quality of life. Several therapies are performed to prevent this, but have not yet been compared in a systematic review.
Methods
A systematic review of the literature and meta-analysis were performed using the MEDLINE, Embase, Cochrane, LILACS, Scopus, and CINAHL databases. Clinical trials and observational studies were searched from March 2014 to February 2015. Search terms included: endoscopy, ESD, esophageal stenosis, and esophageal stricture. Three retrospective and four prospective (three randomized) cohort studies were selected and involved 249 patients with superficial esophageal neoplasia who underwent ESD, at least two-thirds of the circumference. We grouped trials comparing different techniques to prevent esophagus stenosis post-ESD.
Results
We conducted different meta-analyses on randomized clinical trials (RCT), non-RCT, and global analysis. In RCT (three studies,
n
= 85), the preventive therapy decreased the risk of stenosis (risk difference = −0.36, 95 % CI −0.55 to −0.18,
P
= 0.0001). Two studies (one randomized and one non-randomized,
n
= 55) showed that preventative therapy lowered the average number of endoscopy dilatations (mean difference = −8.57, 95 % CI −13.88 to −3.25,
P
< 0.002). There were no significant differences in the three RCT studies (
n
= 85) in complication rates between patients with preventative therapy and those without (risk difference = 0.02, 95 % CI −0.09 to 0.14,
P
= 0.68).
Conclusions
The use of preventive therapy after extensive ESD of the esophagus reduces the risk of stenosis and the number of endoscopic dilatations for resolution of stenosis without increasing the number of complications.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-015-4551-9</identifier><identifier>PMID: 26487197</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Adenocarcinoma - surgery ; Cancer ; Carcinoma, Squamous Cell - surgery ; Clinical trials ; Dissection ; Endoscopic Mucosal Resection - adverse effects ; Endoscopic Mucosal Resection - methods ; Endoscopy ; Esophageal Neoplasms - surgery ; Esophageal Stenosis - etiology ; Esophageal Stenosis - prevention & control ; Esophagoscopy - adverse effects ; Esophagoscopy - methods ; Esophagus ; Gastroenterology ; Gynecology ; Hepatology ; Humans ; Literature reviews ; Lymphatic system ; Medicine ; Medicine & Public Health ; Meta-analysis ; Observational studies ; Postoperative Complications - etiology ; Postoperative Complications - prevention & control ; Prevention ; Proctology ; Quality of Life ; Surgery ; Systematic review ; Tumors</subject><ispartof>Surgical endoscopy, 2016-07, Vol.30 (7), p.2779-2791</ispartof><rights>Springer Science+Business Media New York 2015</rights><rights>Springer Science+Business Media New York 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-f5ea6d1b9218b74a79023781108e6a7fb618d4ab1863d36eab43fade3836132f3</citedby><cites>FETCH-LOGICAL-c372t-f5ea6d1b9218b74a79023781108e6a7fb618d4ab1863d36eab43fade3836132f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-015-4551-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-015-4551-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26487197$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Oliveira, J. F.</creatorcontrib><creatorcontrib>Moura, E. G. H.</creatorcontrib><creatorcontrib>Bernardo, W. M.</creatorcontrib><creatorcontrib>Ide, E.</creatorcontrib><creatorcontrib>Cheng, S.</creatorcontrib><creatorcontrib>Sulbaran, M.</creatorcontrib><creatorcontrib>Santos, C. M. L.</creatorcontrib><creatorcontrib>Sakai, P.</creatorcontrib><title>Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Endoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significantly decreased quality of life. Several therapies are performed to prevent this, but have not yet been compared in a systematic review.
Methods
A systematic review of the literature and meta-analysis were performed using the MEDLINE, Embase, Cochrane, LILACS, Scopus, and CINAHL databases. Clinical trials and observational studies were searched from March 2014 to February 2015. Search terms included: endoscopy, ESD, esophageal stenosis, and esophageal stricture. Three retrospective and four prospective (three randomized) cohort studies were selected and involved 249 patients with superficial esophageal neoplasia who underwent ESD, at least two-thirds of the circumference. We grouped trials comparing different techniques to prevent esophagus stenosis post-ESD.
Results
We conducted different meta-analyses on randomized clinical trials (RCT), non-RCT, and global analysis. In RCT (three studies,
n
= 85), the preventive therapy decreased the risk of stenosis (risk difference = −0.36, 95 % CI −0.55 to −0.18,
P
= 0.0001). Two studies (one randomized and one non-randomized,
n
= 55) showed that preventative therapy lowered the average number of endoscopy dilatations (mean difference = −8.57, 95 % CI −13.88 to −3.25,
P
< 0.002). There were no significant differences in the three RCT studies (
n
= 85) in complication rates between patients with preventative therapy and those without (risk difference = 0.02, 95 % CI −0.09 to 0.14,
P
= 0.68).
Conclusions
The use of preventive therapy after extensive ESD of the esophagus reduces the risk of stenosis and the number of endoscopic dilatations for resolution of stenosis without increasing the number of complications.</description><subject>Abdominal Surgery</subject><subject>Adenocarcinoma - surgery</subject><subject>Cancer</subject><subject>Carcinoma, Squamous Cell - surgery</subject><subject>Clinical trials</subject><subject>Dissection</subject><subject>Endoscopic Mucosal Resection - adverse effects</subject><subject>Endoscopic Mucosal Resection - methods</subject><subject>Endoscopy</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophageal Stenosis - etiology</subject><subject>Esophageal Stenosis - prevention & control</subject><subject>Esophagoscopy - adverse effects</subject><subject>Esophagoscopy - methods</subject><subject>Esophagus</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Literature reviews</subject><subject>Lymphatic system</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Observational studies</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Prevention</subject><subject>Proctology</subject><subject>Quality of Life</subject><subject>Surgery</subject><subject>Systematic review</subject><subject>Tumors</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kUtv1TAQhS0EopfCD2CDLLHpxuBX_GCHKgpIlWDRri0nmZRUSRw8Duj-e3yVghASq1nMd848DiEvBX8jOLdvkXNtNOOiYbppBPOPyEFoJZmUwj0mB-4VZ9J6fUaeId7zinvRPCVn0mhnhbcHsn7N8AOWMqaFpoECpvVbvIM4USx57MqWgcahQKaw9Am7tI4dxa2dty5hpfoREbqT_B2NFI9YYI6lMtV2hJ80Lj2doUQWlzgdccTn5MkQJ4QXD_Wc3F59uLn8xK6_fPx8-f6adcrKwoYGoulF6-slrdXRei6VdUJwBybaoTXC9Tq2whnVKwOx1WqIPSinjFByUOfkYvddc_q-AZYwj9jBNMUF0oZBWG-d5c6air7-B71PW6777pRprNCyUmKnupwQMwxhzeMc8zEIHk5xhD2OUOMIpziCr5pXD871Y9D_Ufz-fwXkDmBtLXeQ_xr9X9dfqq6Wsw</recordid><startdate>20160701</startdate><enddate>20160701</enddate><creator>Oliveira, J. F.</creator><creator>Moura, E. G. H.</creator><creator>Bernardo, W. M.</creator><creator>Ide, E.</creator><creator>Cheng, S.</creator><creator>Sulbaran, M.</creator><creator>Santos, C. M. L.</creator><creator>Sakai, P.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20160701</creationdate><title>Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis</title><author>Oliveira, J. F. ; Moura, E. G. H. ; Bernardo, W. M. ; Ide, E. ; Cheng, S. ; Sulbaran, M. ; Santos, C. M. L. ; Sakai, P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-f5ea6d1b9218b74a79023781108e6a7fb618d4ab1863d36eab43fade3836132f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Abdominal Surgery</topic><topic>Adenocarcinoma - surgery</topic><topic>Cancer</topic><topic>Carcinoma, Squamous Cell - surgery</topic><topic>Clinical trials</topic><topic>Dissection</topic><topic>Endoscopic Mucosal Resection - adverse effects</topic><topic>Endoscopic Mucosal Resection - methods</topic><topic>Endoscopy</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophageal Stenosis - etiology</topic><topic>Esophageal Stenosis - prevention & control</topic><topic>Esophagoscopy - adverse effects</topic><topic>Esophagoscopy - methods</topic><topic>Esophagus</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Literature reviews</topic><topic>Lymphatic system</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Observational studies</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Prevention</topic><topic>Proctology</topic><topic>Quality of Life</topic><topic>Surgery</topic><topic>Systematic review</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Oliveira, J. F.</creatorcontrib><creatorcontrib>Moura, E. G. H.</creatorcontrib><creatorcontrib>Bernardo, W. M.</creatorcontrib><creatorcontrib>Ide, E.</creatorcontrib><creatorcontrib>Cheng, S.</creatorcontrib><creatorcontrib>Sulbaran, M.</creatorcontrib><creatorcontrib>Santos, C. M. L.</creatorcontrib><creatorcontrib>Sakai, P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Oliveira, J. F.</au><au>Moura, E. G. H.</au><au>Bernardo, W. M.</au><au>Ide, E.</au><au>Cheng, S.</au><au>Sulbaran, M.</au><au>Santos, C. M. L.</au><au>Sakai, P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2016-07-01</date><risdate>2016</risdate><volume>30</volume><issue>7</issue><spage>2779</spage><epage>2791</epage><pages>2779-2791</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Endoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significantly decreased quality of life. Several therapies are performed to prevent this, but have not yet been compared in a systematic review.
Methods
A systematic review of the literature and meta-analysis were performed using the MEDLINE, Embase, Cochrane, LILACS, Scopus, and CINAHL databases. Clinical trials and observational studies were searched from March 2014 to February 2015. Search terms included: endoscopy, ESD, esophageal stenosis, and esophageal stricture. Three retrospective and four prospective (three randomized) cohort studies were selected and involved 249 patients with superficial esophageal neoplasia who underwent ESD, at least two-thirds of the circumference. We grouped trials comparing different techniques to prevent esophagus stenosis post-ESD.
Results
We conducted different meta-analyses on randomized clinical trials (RCT), non-RCT, and global analysis. In RCT (three studies,
n
= 85), the preventive therapy decreased the risk of stenosis (risk difference = −0.36, 95 % CI −0.55 to −0.18,
P
= 0.0001). Two studies (one randomized and one non-randomized,
n
= 55) showed that preventative therapy lowered the average number of endoscopy dilatations (mean difference = −8.57, 95 % CI −13.88 to −3.25,
P
< 0.002). There were no significant differences in the three RCT studies (
n
= 85) in complication rates between patients with preventative therapy and those without (risk difference = 0.02, 95 % CI −0.09 to 0.14,
P
= 0.68).
Conclusions
The use of preventive therapy after extensive ESD of the esophagus reduces the risk of stenosis and the number of endoscopic dilatations for resolution of stenosis without increasing the number of complications.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>26487197</pmid><doi>10.1007/s00464-015-4551-9</doi><tpages>13</tpages></addata></record> |
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| subjects | Abdominal Surgery Adenocarcinoma - surgery Cancer Carcinoma, Squamous Cell - surgery Clinical trials Dissection Endoscopic Mucosal Resection - adverse effects Endoscopic Mucosal Resection - methods Endoscopy Esophageal Neoplasms - surgery Esophageal Stenosis - etiology Esophageal Stenosis - prevention & control Esophagoscopy - adverse effects Esophagoscopy - methods Esophagus Gastroenterology Gynecology Hepatology Humans Literature reviews Lymphatic system Medicine Medicine & Public Health Meta-analysis Observational studies Postoperative Complications - etiology Postoperative Complications - prevention & control Prevention Proctology Quality of Life Surgery Systematic review Tumors |
| title | Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis |
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