Efficacy and safety of submucosal tunneling endoscopic resection for subepithelial tumors in the upper GI tract: a systematic review and meta-analysis of >2900 patients

Abstract

Background and aims: Submucosal tunnel endoscopic resection (STER) is an emerging therapeutic tool that allows direct visualization and resection of submucosal tunneling endoscopic resection (SETs) from the upper GI tract while maintaining the integrity of the mucosa. Our aim was to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of STER in treating all types of SETs found in the upper GI tract. Methods: A comprehensive search of major databases such as PubMed/Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane, Web of Science, and Google Scholar was conducted to identify studies that reported on STER. The primary outcomes were R0 resection, en bloc resection, and adverse events (AEs) of STER. Secondary analysis was performed for different regions of the upper GI tract, recurrence rate, and various adverse events. Results: Eighteen studies with 2941 patients were included; the mean age was 49.74 years, and 61.82% were male. Pooled rates for the overall R0 resection, en bloc resection, and AEs were 92.4%, 91.5%, and 17.8%, respectively. However, only 1.2% of AEs were considered severe. The en bloc resection rate for the tumors in the esophagogastric junction layer was lower at 81.5%. The R0 and en bloc resection rates for tumors originating from the muscularis propria layer were also lower (88.3% and 89.1%). Gas-related adverse events were the most frequent AE with a rate of 5.9%. The recurrence rate was 2.3%. Conclusions: Our meta-analysis showed that STER is overall an effective and safe therapeutic modality to remove SETs from the upper GI tract.