Clinical Outcomes of Endoscopic Submucosal Tunnel Dissection Vs Endoscopic Submucosal Dissection in Gastric Lesions: a Systematic Review and Meta-analysis

Abstract Background and objectives: Many studies have verified that endoscopic submucosal dissection (ESD) has prominent advantages in en bloc resection and low recurrence rate. However, ESD also has technical difficulty for some large-area gastric lesions. Endoscopic submucosal tunneling dissection (ESTD) combined the tunnel technique with the traditional ESD technique for treating gastrointestinal mucosal lesions under tunnel endoscopy. This technique has been gradually applied to the treatment of large-scale early cancer and precancerous lesions, and has achieved good results. Yet no meta-analysis has been published, so we performed this study to determine the efficacy and safety of ESTD vs ESD in gastric lesions through clinical outcomes.Methods: We performed the literature search in PubMed, Cochrane Library, Web of Science, Embase, Wanfang, and CNKI dating up to February 9, 2021. Studies comparing the clinical outcomes of ESTD and ESD in gastric lesions were enrolled. The Newcastle-Ottawa Quality Assessment Scale was used to evaluate the quality of these studies. Results: Four articles were included that involved a total of 920 patients (187 from the ESTD group and 733 from ESD group). ESTD has higher en bloc resection and R0 resection rate, faster dissection speed, and lower complication rate. The curative resection rate and recurrence rate of ESTD group is comparable with ESD group.Conclusions: ESTD technique is an effective and safe treatment procedure in gastric lesions, and may be prior to ESD for large gastric lesions.