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

doi:10.4240/wjgs.v16.i11.3568

Outcome and risk factors of ulcer healing after gastric endoscopic submucosal dissection: A systematic review and meta-analysis

World J Gastrointest Surg. 2024 Nov 27;16(11):3568-3577. doi: 10.4240/wjgs.v16.i11.3568.

Authors

De-Yi Chen¹, Hai-Dong Chen², Xiao-Dan Lv³, Zhou Huang⁴, Dan Jiang¹, Yu Li¹, Bing Han¹, Li-Chun Han¹, Xiao-Fang Xu¹, Shi-Quan Li¹, Guang-Fu Lin¹, Zhi-Xi Huang¹, Jia-Ning Lin¹, Xiao-Ping Lv⁵

Affiliations

¹ Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
² Department of Gastroenterology, The Tenth Affiliated Hospital of Guangxi Medical University, Qinzhou 535000, Guangxi Zhuang Autonomous Region, China.
³ Department of Clinical Experimental Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
⁴ Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
⁵ Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China. lxxp58@hotmail.com.

Abstract

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.

Keywords: Artificial ulcer; Endoscopic submucosal dissection; Gastric ulcer; Meta-analysis; Outcome; Risk factors; Systematic review.