带结扎装置的内镜下黏膜切除术与内镜黏膜下剥离术治疗直肠神经内分泌肿瘤（ ≤ 10 mm）疗效的Meta分析

Meta-analysis of endoscopic mucosal resection with ligation device and endoscopic submucosal dissection in treatment of rectal neuroendocrine neoplasm ( ≤ 10 mm)

摘要:

目的 系统评价带结扎装置的内镜下黏膜切除术（EMR-L）与内镜黏膜下剥离术（ESD）治疗直肠神经内分泌肿瘤（rNEN）（ ≤ 10 mm）的有效性和安全性。方法 计算机检索the Cochrane Library、PubMed、Embase、Web of Science、SinoMed、中国知网、维普数据库和万方数据库，时限为建库至2023年12月13日，收集观察EMR-L与ESD治疗rNEN疗效的文献，由两位研究者独立筛选文献并提取数据，采用纽卡斯尔-渥太华量表（NOS）进行文献质量评价，应用Rev Man 5.3软件行Meta分析，并绘制漏斗图，采用STATA 18.0软件行发表偏倚检测。结果 最终有14篇文献纳入研究，共报道患者1 234例。其中，EMR-L组488例，ESD组518例，其他术式228例。Meta分析结果显示：两组患者组织学完全切除率比较，差异无统计学意义（OR＾ = 1.24，95%CI：0.54～2.86，P = 0.610）；两组患者病变直径比较，差异无统计学意义（WMD = -0.27，95%CI：-0.77～0.23，P = 0.290）；EMR-L组手术时间明显短于ESD组（WMD = -12.71，95%CI：-17.51～-7.92，P = 0.000）；两组患者水平和垂直切缘阳性率比较，差异无统计学意义（P > 0.05）；两组患者并发症总发生率、术后延迟出血发生率和肠穿孔发生率比较，差异均无统计学意义（P > 0.05）。结论 与ESD相比，EMR-L治疗直径 ≤ 10 mm的rNEN手术时间更短，并未增加手术风险，疗效相当，且操作简便，对手术器械和内镜医师的操作技术要求不高，更适于临床推广。

Abstract:

Objective To evaluate the safety and effectiveness of endoscopic mucosal resection with ligation device (EMR-L) and endoscopic submucosal dissection (ESD) for the rectal neuroendocrine neoplasm (rNEN) ( ≤ 10 mm).Methods Databases such as the Cochrane Library, PubMed, Embase, Web of Science, SinoMed, China National Knowledge Infrastructure, Weipu and Wanfang database were searched by computer. The retrieval time limit was December 13, 2023. The literatures on the efficacy of EMR-L and ESD in treatment of rNEN patients were collected. Two researchers independently screened the literatures and extracted the data, evaluated the methodological quality by Newcastle-Ottawa Scale (NOS). The Rev Man 5.3 software was used for Meta-analysis and funnel plot, and STATA 18.0 was used for publication bias detection.Results 14 literatures were included in the study involving 1,234 patients, including 488 patients in the EMR-L group, 518 patients in the ESD group and other operation types 228 cases. Meta-analysis showed that there was no significant difference in histological complete resection rate between the EMR-L group and the ESD group (OR＾ = 1.24, 95%CI: 0.54～2.86, P = 0.610); The difference was not statistically significant of lesion diameter (WMD = -0.27, 95%CI: -0.77～0.23, P = 0.290); The operative time of EMR-L group was significantly shorter than that of ESD (WMD = -12.71, 95%CI: -17.51～-7.92, P = 0.000); There was no significant difference in the positive rate of horizontal and vertical margins between groups (P > 0.05). There were no significant differences in the incidence of total complications, postoperative delayed bleeding and intestinal perforation among the groups (P > 0.05).Conclusion Compared with ESD, the treatment of rNEN with diameter ≤ 10 mm by EMR-L is comparable effective and save more time. EMR-L is suitable for extensive using because of simple technical requirements for surgical instruments and endoscopists.