Efficacy and Safety of Endoscopic Submucosal Dissection for Dysplasia in Ulcerative Colitis Patients: A Systematic Review and Meta-Analysis
Background and Aims. Ulcerative colitis (UC) is associated with an increased risk of colorectal cancer. Current guidelines recommend endoscopic resection if the lesion is visible with distinct margins and a complete resection can be achieved. However, submucosal fibrosis due to chronic inflammation...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2022/9556161 |
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| author | Qi-Shan Zeng Zhi-Jing Zhao Jiao Nie Min Zou Jia-Hui Yang Jin-Zhi Zhang Hua-Tian Gan |
| author_facet | Qi-Shan Zeng Zhi-Jing Zhao Jiao Nie Min Zou Jia-Hui Yang Jin-Zhi Zhang Hua-Tian Gan |
| author_sort | Qi-Shan Zeng |
| collection | DOAJ |
| description | Background and Aims. Ulcerative colitis (UC) is associated with an increased risk of colorectal cancer. Current guidelines recommend endoscopic resection if the lesion is visible with distinct margins and a complete resection can be achieved. However, submucosal fibrosis due to chronic inflammation may increase the procedural risk and reduce the complete resection rate. The aim of this study is to assess the efficacy and safety of endoscopic submucosal dissection (ESD) for dysplasia in UC patients. Materials and Methods. A systematic search of databases was performed until May 30, 2021. Studies that reported the resection rates and complication rates of ESD for dysplasia in UC patients were included. A random-effects model was used to generate conservative estimates of the prevalence of the outcome variables. All data analyses were performed using software Stata (version 15). Results. 8 studies were enrolled in the meta-analysis, with a total of 203 dysplastic lesions in 192 UC patients. The mean lesion size was 26.7 mm. About 83% of the lesions were located in the left-side colon, and 90% of the lesions were nonpolypoid, and about 71% of the lesions had submucosal fibrosis. The mean procedural time of ESD was 83 minutes. The en bloc resection rate, complete resection rate, and curative resection rate were 94%, 84%, and 81%, respectively, with a local recurrence rate of 5%. The pooled prevalence of bleeding and perforation were 8% and 6%, respectively. The rates of metachronous tumors and additional surgery after ESD were 6% and 10%, respectively. Conclusion. Despite some limitations, our study suggests that ESD is an effective and safe treatment for dysplasia in UC patients. However, randomized controlled multicenter studies with less heterogeneity and longer follow-up are needed to better assess the clinical outcomes of ESD in UC patients. |
| format | Article |
| id | doaj-art-6647b17489ef4555a0c57837ebf86b68 |
| institution | Kabale University |
| issn | 1687-630X |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Gastroenterology Research and Practice |
| spelling | doaj-art-6647b17489ef4555a0c57837ebf86b682025-02-03T06:12:29ZengWileyGastroenterology Research and Practice1687-630X2022-01-01202210.1155/2022/9556161Efficacy and Safety of Endoscopic Submucosal Dissection for Dysplasia in Ulcerative Colitis Patients: A Systematic Review and Meta-AnalysisQi-Shan Zeng0Zhi-Jing Zhao1Jiao Nie2Min Zou3Jia-Hui Yang4Jin-Zhi Zhang5Hua-Tian Gan6Department of Gastroenterology and the Center of Inflammatory Bowel DiseaseDepartment of GastroenterologyDepartment of Gastroenterology and National Clinical Research Center for GeriatricsDepartment of Gastroenterology and the Center of Inflammatory Bowel DiseaseDepartment of Gastroenterology and National Clinical Research Center for GeriatricsDepartment of Gastroenterology and National Clinical Research Center for GeriatricsDepartment of Gastroenterology and the Center of Inflammatory Bowel DiseaseBackground and Aims. Ulcerative colitis (UC) is associated with an increased risk of colorectal cancer. Current guidelines recommend endoscopic resection if the lesion is visible with distinct margins and a complete resection can be achieved. However, submucosal fibrosis due to chronic inflammation may increase the procedural risk and reduce the complete resection rate. The aim of this study is to assess the efficacy and safety of endoscopic submucosal dissection (ESD) for dysplasia in UC patients. Materials and Methods. A systematic search of databases was performed until May 30, 2021. Studies that reported the resection rates and complication rates of ESD for dysplasia in UC patients were included. A random-effects model was used to generate conservative estimates of the prevalence of the outcome variables. All data analyses were performed using software Stata (version 15). Results. 8 studies were enrolled in the meta-analysis, with a total of 203 dysplastic lesions in 192 UC patients. The mean lesion size was 26.7 mm. About 83% of the lesions were located in the left-side colon, and 90% of the lesions were nonpolypoid, and about 71% of the lesions had submucosal fibrosis. The mean procedural time of ESD was 83 minutes. The en bloc resection rate, complete resection rate, and curative resection rate were 94%, 84%, and 81%, respectively, with a local recurrence rate of 5%. The pooled prevalence of bleeding and perforation were 8% and 6%, respectively. The rates of metachronous tumors and additional surgery after ESD were 6% and 10%, respectively. Conclusion. Despite some limitations, our study suggests that ESD is an effective and safe treatment for dysplasia in UC patients. However, randomized controlled multicenter studies with less heterogeneity and longer follow-up are needed to better assess the clinical outcomes of ESD in UC patients.http://dx.doi.org/10.1155/2022/9556161 |
| spellingShingle | Qi-Shan Zeng Zhi-Jing Zhao Jiao Nie Min Zou Jia-Hui Yang Jin-Zhi Zhang Hua-Tian Gan Efficacy and Safety of Endoscopic Submucosal Dissection for Dysplasia in Ulcerative Colitis Patients: A Systematic Review and Meta-Analysis Gastroenterology Research and Practice |
| title | Efficacy and Safety of Endoscopic Submucosal Dissection for Dysplasia in Ulcerative Colitis Patients: A Systematic Review and Meta-Analysis |
| title_full | Efficacy and Safety of Endoscopic Submucosal Dissection for Dysplasia in Ulcerative Colitis Patients: A Systematic Review and Meta-Analysis |
| title_fullStr | Efficacy and Safety of Endoscopic Submucosal Dissection for Dysplasia in Ulcerative Colitis Patients: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Efficacy and Safety of Endoscopic Submucosal Dissection for Dysplasia in Ulcerative Colitis Patients: A Systematic Review and Meta-Analysis |
| title_short | Efficacy and Safety of Endoscopic Submucosal Dissection for Dysplasia in Ulcerative Colitis Patients: A Systematic Review and Meta-Analysis |
| title_sort | efficacy and safety of endoscopic submucosal dissection for dysplasia in ulcerative colitis patients a systematic review and meta analysis |
| url | http://dx.doi.org/10.1155/2022/9556161 |
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