| Objective:Although endoscopic submucosal dissection(ESD)is a commonly used treatment for superficial esophageal neoplastic lesions(SENL)at present,endoscopic submucosal tunnel dissection(ESTD)as an innovative technology has also achieved significant effects on SENL in recent years.As the clinical efficacy and safety of ESD versus ESTD are still unclear,this study systematically evaluated the clinical efficacy and safety of ESTD and ESD in the treatment of SENL through the method of Meta-analysis.Methods:According to the PICOS principle,a search strategy was developed,and all Chinese and English controlled studies on ESTD and ESD treatment of SENL in Pub Med,Web of Science,Cochrane Library,Sino Med,CNKI,and Wanfang were searched systematically.Two researchers independently screened the literature according to the established inclusion and exclusion criteria,and then conducted quality evaluation and data extraction on the included studies.It mainly includes surgical efficiency indicators(en bloc resection rate,CURATIVE resection rate,operation time),clinical efficacy indicators(dissection area,dissection speed,and postoperative recurrence)and safety indicators(esophageal perforation,intraoperative bleeding,postoperative bleeding,esophageal stenosis,etc.).Meta-analysis was performed on the extracted data using the“meta”package in RStudio software.For binary variables,odds ratio(OR)and 95%confidence interval(CI)were used as effect sizes for pooled analysis.For continuous variables,standardized mean difference(SMD)and 95%CI were used as effect sizes for the pooled analysis.Mantel-Haenszel method was used to calculate the pooled effect value.If P≤0.05,it was considered that the pooled effect size of multiple studies had statistical significance.The heterogeneity of the included articles was represented by I~2statistics,and random effect model or fixed effect model were used for combined analysis according to the level of heterogeneity.Sensitivity analysis assesses the robustness of the results by removing individual studies and re-pooled the analysis.Use the effect size as the abscissa and the standard error as the ordinate to establish a funnel chart and judge whether there is a publication bias.Results:A total of 19 studies with 1161 patients were identified and included in the meta-analysis.The results of meta-analysis showed that in terms of surgical efficiency,the operative time of the ESTD group was lower than that of the ESD group,and the difference was statistically significant(SMD=-0.51,95%CI:-0.84～-0.19,P=0.002).The dissection area in the ESTD group was greater than that in the ESD group,and the difference was statistically significant(SMD=0.50,95%CI:0.22～0.79,P<0.001).The reported area of esophageal lesions in the ESTD group was significantly larger than that in the ESD group,and the difference was statistically significant(SMD=0.28;95%CI:0.11～0.44;P=0.001);The dissection speed in ESTD group was faster than that in ESD group,and the difference was statistically significant(SMD=1.35,95%CI:0.95-0.1.76,P<0.001).In terms of clinical efficacy,the en bloc resection rate of the ESTD group was 99.28%(555/559),while that of the ESD group was 94.93%(655/690),the difference was statistically significant(OR=4.21,95%CI:1.93-9.15,P<0.001).The curative resection rate of the ESTD group was 92.48%(541/585),while that of the ESD group was 85.89%(615/716),the difference was statistically significant(OR=2.44,95%CI:1.65-3.61,P<0.001).The postoperative recurrence rate of the ESTD group was 0.7%(1/148),while that of the ESD group was 10.7%(16/149),and the difference was statistically significant(OR=0.17;95%CI:0.05～0.55;P=0.003).In terms of safety,the incidence of esophageal perforation in the ESTD group was 0.71%(3/424),while that in the ESD group was 4.10%(22/537),and the difference was statistically significant(OR=0.34,95%CI:0.15-0.74,P=0.007).The incidence of intraoperative bleeding in the ESTD group was 15.52%(43/277),while that in the ESD group was 28.84%(92/317),the difference was statistically significant(OR=0.45,95%CI:0.29-0.68,P<0.001).The incidence of postoperative bleeding was 1.63%(7/430)in the ESTD group and 4.22%(22/521)in the ESD group,and the difference was statistically significant(OR=0.44,95%CI:0.21-0.91,P=0.03).The incidence of intraoperative esophageal muscle injury in the ESTD group was 17.07%(50/293),while that in the ESD group was30.44%(126/414),the difference was statistically significant(OR=0.43,95%CI:0.29-0.63,P<0.001).The incidence of esophageal stenosis was 16.19%(34/210)in the ESTD group and 22.38%(47/281)in the ESD group,and the difference was not statistically significant(OR=0.91,95%CI:0.38-2.21,P=0.84).Conclusion:ESTD has a significant advantage over ESD in the treatment of SENL.ESTD has significantly higher en bloc resection and CURATIVE resection rates and reduced adverse events.However,large-scale prospective randomized controlled studies and long-term follow-up are still needed to verify the results of this study. |
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