Efficacy and safety of endoscopic submucosal dissection for superficial squamous esophageal neoplasia: A meta-analysis

Background and Aims: Although endoscopic submucosal dissection (ESD) has grown popular in resecting lesions in the stomach, the application of ESD to the esophagus has been limited by greater technical difficulty. An increasing number of series have recently reported the application of ESD to esophageal lesions. The aim of the present systemic review and meta-analysis was to evaluate the efficacy and safety of ESD for esophageal lesions. Methods: Comprehensive literature searches (1999-2012) were performed on studies that reported ESD for the removal of esophageal neoplasia. Primary outcome measures were pooled estimates of complete resection rate and en bloc resection rate. Secondary outcome measures were pooled estimates of complication rates. Results: A total of 15 studies provided data on 776 ESD-treated lesions. The pooled estimate of complete resection rate was 89.4 % (95 % CI 86.2-91.9 %). The pooled estimate of en bloc resection was 95.1 % (95 % CI 92.6-96.8 %). The pooled estimates of complications of ESD such as bleeding, perforation, and stenosis were 2.1, 5.0, and 11.6 %, respectively. Conclusions: ESD appeared to be an extremely effective technique to achieve complete resection of esophageal neoplasia. The very low rate of complications also shows the potential safety of this approach.