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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Outcome and risk factors of ulcer healing after gastric endoscopic submucosal dissection: A systematic review and meta-analysis
De-Yi Chen, Hai-Dong Chen, Xiao-Dan Lv, Zhou Huang, Dan Jiang, Yu Li, Bing Han, Li-Chun Han, Xiao-Fang Xu, Shi-Quan Li, Guang-Fu Lin, Zhi-Xi Huang, Jia-Ning Lin, Xiao-Ping Lv
De-Yi Chen, Dan Jiang, Yu Li, Bing Han, Li-Chun Han, Xiao-Fang Xu, Shi-Quan Li, Guang-Fu Lin, Zhi-Xi Huang, Jia-Ning Lin, Xiao-Ping Lv, Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Hai-Dong Chen, Department of Gastroenterology, The Tenth Affiliated Hospital of Guangxi Medical University, Qinzhou 535000, Guangxi Zhuang Autonomous Region, China
Xiao-Dan Lv, Department of Clinical Experimental Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Zhou Huang, Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: Chen DY and Chen HD conducted a literature research and search, developed a methodology, collected data, performed statistical analysis and quality evaluation, evaluated the results, and wrote the manuscript; Lv XD, Huang Z and Jiang D conducted a literature search, gathered data, performed statistical analysis, and evaluated the product’s quality; Li Y and Han B analyzed the information, made important recommendations, and edited the paper; Li SQ, Han LC, and Xu XF examined the information and made important recommendations; Lin JN, Huang ZX, and Lin GF looked over the information; Lv XP designed the project, created the procedure, performed the statistical analysis, evaluated the outcome, looked over the information, and reviewed the paper.
Supported by the National Natural Science Foundation of China, No. 81860104; the Joint Project on Regional High-Incidence Diseases Research of Guangxi Natural Science Foundation, No. 2023GXNSFDA026024; the Development and Application of Medical and Health Appropriate Technology Project in Guangxi Zhuang Autonomous Region, No. S2018049; the Self-financing Project of Health Commission of Guangxi Zhuang Autonomous Region, No. Z20200398; and the Innovation Project of Guangxi Graduate Education, No. YCBZ2022079.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Xiao-Ping Lv, MD, Chief Physician, Professor, Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
lxxp58@hotmail.com
Received: July 1, 2024
Revised: September 1, 2024
Accepted: September 29, 2024
Published online: November 27, 2024
Processing time: 121 Days and 2.6 Hours
BACKGROUND
Endoscopic submucosal dissection (ESD) is widely utilized for the treatment of large adenomas, submucosal lesions, and early gastric cancer. A significant artificial ulcer typically forms after ESD. Delayed or incomplete healing of these ulcers can result in complications such as delayed bleeding and perforation. However, a comprehensive review of the outcomes and risk factors related to ulcer healing following ESD is currently lacking.
AIM
To assess ulcer healing outcomes and identify risk factors associated with delayed ulcer healing.
METHODS
Databases retrieved by computer include PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang Data, and VIP. The study collects reports on ESD post-surgical ulcer healing outcomes and risk factors, using Stata 16.0 and RevMan 5.0 software for meta-analysis.
RESULTS
Our analysis included 12 studies, involving a total of 3430 patients. The meta-analysis revealed an overall healing rate of 65.55% for ulcers following ESD [odds ratio (OR) = 2.71; 95% confidence interval (CI): 2.45-3.00]. The healing rate within eight weeks was 48.32% (OR = 0.76; 95%CI: 0.35-1.66), while the rate beyond eight weeks was 88.32% (OR = 6.73; 95%CI: 3.82-11.87). Risk factors included Helicobacter pylori (H. pylori) infection (OR: = 5.32; 95%CI: 1.90-14.87; P = 0.001), ulcer size (OR = 2.08; 95%CI: 1.19-3.61; P = 0.01), lesion site (OR = 2.08; 95%CI: 1.19-3.11), and pathological type (OR = 1.64; 95%CI: 1.06-2.52). Diabetes (OR = 0.56; 95%CI: 0.05-5.80; P = 0.63) and duration of operation (OR = 1.00; 95%CI: 0.99-1.01; P = 0.96) were not significant factors.
CONCLUSION
The healing rate of ulcers following ESD is high after eight weeks. Risk factors affecting the healing process include H. pylori infection, ulcer size, lesion site, and pathological type.
Core Tip: The factors influencing the healing of artificial ulcers created by endoscopic submucosal dissection (ESD) remain unclear. This study examines ulcer healing outcomes and the risks associated with delayed healing. The healing rate of ulcers following ESD is high after eight weeks. Treatment for eight weeks or longer may support complete ulcer healing. A meta-analysis of risk factors, based on multivariate regression analysis, indicates that ulcer size, lesion site, Helicobacter pylori infection, and pathological type are key variables affecting the healing process, while diabetes and the duration of the operation do not have a significant impact.
