Diagnostic yield of deep biopsy via endoscopic submucosal dissection for the diagnosis of upper gastrointestinal subepithelial tumors: a systematic review and meta-analysis

Amaninder Dhaliwal; Sindhura Kolli; Banreet Singh Dhindsa; Harmeet Singh Mashiana; Neil Bhogal; Ishfaq Bhat; Shailender Singh; Douglas G Adler

doi:10.20524/aog.2019.0444

Diagnostic yield of deep biopsy via endoscopic submucosal dissection for the diagnosis of upper gastrointestinal subepithelial tumors: a systematic review and meta-analysis

Ann Gastroenterol. 2020 Jan-Feb;33(1):30-37. doi: 10.20524/aog.2019.0444. Epub 2019 Nov 29.

Authors

Amaninder Dhaliwal¹, Sindhura Kolli², Banreet Singh Dhindsa³, Harmeet Singh Mashiana¹, Neil Bhogal¹, Ishfaq Bhat¹, Shailender Singh¹, Douglas G Adler⁴

Affiliations

¹ Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha (Amaninder Dhaliwal, Singh Mashiana, Neil Bhogal, Ishfaq Bhat, Shailender Singh).
² Department of Internal Medicine, The Brooklyn Hospital Center, New York (Sindhura Kolli).
³ Department of Internal Medicine, University of Nevada Las Vegas School of Medicine (Banreet Singh Dhindsa).
⁴ Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah (Douglas G. Adler), USA.

Abstract

Background: Conventionally, endoscopic ultrasound-guided fine-needle aspiration and biopsy (EUS-FNA)/EUS-FNB) has been used for tissue diagnosis of upper gastrointestinal (GI) subepithelial tumors (SETs). However, deep biopsy (DB) via endoscopic submucosal dissection (ESD) is emerging as an alternative technique, given the inadequate tissue sampling with EUS-FNA/EUS-FNB. Our aim was to conduct a systematic review and meta-analysis to report the overall diagnostic yield of DB via ESD for upper GI SETs.

Methods: PubMed, Cochrane Library and Web of Science databases were searched to identify studies (from commencement to Oct 2017) that reported the DB via ESD technique for diagnosis of upper GI SETs. The primary outcome of interest was the method's overall diagnostic yield and the secondary outcome was to the occurrence of complications. The meta-analysis was performed using the DerSimonian and Laird random-effects model.

Results: A total of 7 studies, comprising 209 patients with a mean age of 57.3 years, were included in the final meta-analysis. The overall pooled diagnostic yield of DB via ESD for upper GI SETs was 95% (95% confidence interval [CI] 84.91-99.98, I²=78.2%). Overall, pooled outcomes of major bleeding and perforation in our meta-analysis was noted in 0.07% (95%CI 0.00-2.32, I²=0%) and 0% (95%CI 0.00-1.70, I²=0%) respectively. Data regarding major bleeding and perforation rates were not reported in 2 studies. Substantial heterogeneity was observed in our meta-analysis.

Conclusion: DB via ESD is an effective and safe procedure for diagnosing upper GI SETs. Further multicenter randomized controlled trials are needed to validate these findings.

Keywords: Deep biopsy; subepithelial tumors; submucosal dissection.