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Endoscopic full-thickness resection of colorectal lesions: a systematic review and meta-analysis
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2021-10-07 , DOI: 10.1016/j.gie.2021.09.039
Russell D Dolan 1 , Ahmad Najdat Bazarbashi 1 , Thomas R McCarty 1 , Christopher C Thompson 1 , Hiroyuki Aihara 1
Affiliation  

Background and Aims

Endoscopic full-thickness resection (EFTR) is a novel endoscopic technique for the resection of GI lesions not amenable to standard endoscopic therapy. The primary aim of this study was to perform a systematic review and meta-analysis to evaluate EFTR for the resection of colorectal lesions.

Methods

Individualized searches were developed through October 2020 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. Random-effects models were used to determine pooled technical success, margin-negative (R0) resection, adverse events, procedure duration, and rate of recurrence at follow-up. Subgroup analysis was used to assess the impact of specific procedure techniques and regression analyses to determine influence of lesion size. Heterogeneity was assessed with I2 statistics and publication bias by funnel plots using Egger and Begg tests.

Results

Fourteen studies (1936 subjects; 39.6% women) were included. Most EFTR lesions were located in the colon (75.8%) with the remaining in the rectum. Mean procedure duration was 45.4 ± 11.4 minutes. Pooled technical success was 87.6% (95% confidence interval [CI], 85.1-89.8; I2 = 33), R0 resection rate was 78.8% (95% CI, 75.7-81.5; I2 = 33), procedure-associated adverse events occurred in 12.2% (95% CI, 9.3-15.9; I2 = 61), and recurrence rate was 12.6% (95% CI, 11.1-14.4; I2 = 0) over an average weighted follow-up of 20.1 ± 3.8 weeks. Regression analyses revealed significantly lower R0 resection (odds ratio, .3; 95% CI, .2-.6; I2 = 61; P = .0003) and higher overall procedure-associated adverse event rates (odds ratio, 3.5; 95% CI, 1.8-7.2; I2 = 55; P = .0004) for lesions >20 mm.

Conclusions

EFTR overall appears to be an effective modality with high technical success and R0 resection rate with a relatively low risk of adverse events and recurrence, with greatest success when lesions are <20 mm.



中文翻译:

结直肠病变的内镜全层切除术:系统评价和荟萃分析

背景和目标

内窥镜全层切除术 (EFTR) 是一种新型内窥镜技术,用于切除不适合标准内窥镜治疗的胃肠道病变。本研究的主要目的是进行系统回顾和荟萃分析,以评估 EFTR 在结直肠病变切除中的作用。

方法

根据系统评价和荟萃分析的首选报告项目以及流行病学观察研究的荟萃分析指南,个性化搜索在 2020 年 10 月之前进行了开发。随机效应模型用于确定汇总的技术成功、切缘阴性 (R 0 ) 切除、不良事件、手术持续时间和随访时的复发率。亚组分析用于评估特定手术技术的影响,回归分析用于确定病变大小的影响。使用 Egger 和 Begg 检验通过漏斗图通过I 2统计和发表偏倚评估异质性。

结果

包括 14 项研究(1936 名受试者;39.6% 的女性)。大多数 EFTR 病变位于结肠 (75.8%),其余位于直肠。平均手术持续时间为 45.4 ± 11.4 分钟。汇总技术成功率为 87.6%(95% 置信区间 [CI],85.1-89.8;I 2  = 33),R 0切除率为 78.8%(95% CI,75.7-81.5;I 2  = 33),与手术相关不良事件发生率为 12.2%(95% CI,9.3-15.9;I 2 = 61), 平均加权随访 20.1 的 复发率为 12.6%(95% CI,11.1-14.4;I 2 = 0) ± 3.8 周。回归分析显示 R 0切除率显着降低(比值比,0.3;95% CI,0.2-0.6;2  = 61; P  = .0003) 和更高的总体手术相关不良事件发生率(比值比,3.5;95% CI,1.8-7.2;I 2  = 55;P  = .0004)>20 mm 的病变。

结论

EFTR 总体上似乎是一种有效的方式,具有很高的技术成功率和 R 0切除率,不良事件和复发风险相对较低,当病变 <20 mm 时取得最大成功。

更新日期:2021-10-07
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