Authors: J F Oliveira E G H Moura W M Bernardo E Ide S Cheng M Sulbaran C M L Santos P Sakai
Publish Date: 2015/10/20
Volume: 30, Issue: 7, Pages: 2779-2791
Abstract
Endoscopic submucosal dissection ESD of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis resulting in significantly decreased quality of life Several therapies are performed to prevent this but have not yet been compared in a systematic reviewA systematic review of the literature and metaanalysis were performed using the MEDLINE Embase Cochrane LILACS Scopus and CINAHL databases Clinical trials and observational studies were searched from March 2014 to February 2015 Search terms included endoscopy ESD esophageal stenosis and esophageal stricture Three retrospective and four prospective three randomized cohort studies were selected and involved 249 patients with superficial esophageal neoplasia who underwent ESD at least twothirds of the circumference We grouped trials comparing different techniques to prevent esophagus stenosis postESDWe conducted different metaanalyses on randomized clinical trials RCT nonRCT and global analysis In RCT three studies n = 85 the preventive therapy decreased the risk of stenosis risk difference = −036 95 CI −055 to −018 P = 00001 Two studies one randomized and one nonrandomized n = 55 showed that preventative therapy lowered the average number of endoscopy dilatations mean difference = −857 95 CI −1388 to −325 P 0002 There were no significant differences in the three RCT studies n = 85 in complication rates between patients with preventative therapy and those without risk difference = 002 95 CI −009 to 014 P = 068
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