The efficacy and safety of endoscopic submucosal resection in periappendiceal lesions: a systematic review and meta-analysis.

Abstract

Introduction: Endoscopic submucosal dissection (ESD) is a promising technique for early-stage gastrointestinal neoplasms; however, its use for periappendiceal lesions poses challenges because of anatomical complexities and the potential risk of appendicitis or perforation. As a result, these lesions are often managed surgically. This systematic review and meta-analysis evaluate the safety and efficacy of ESD for periappendiceal lesions.

Methodology: A systematic search across multiple databases was conducted, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies focused on adult populations undergoing ESD for periappendiceal lesions. The primary outcome was a technical success, and secondary outcomes included R0 resection, en-bloc resection, adverse events, and need for surgery. Data were reported using percentages with associated confidence intervals (CIs) and heterogeneity (I²).

Results: Six studies comprising 298 patients were included. Technical success was achieved in 98% (95% CI: 97-100%, I2 : 4.63%), with R0 resection and en-bloc resection rates of 84% (95% CI: 77-91%, I2 : 61.86%) and 92% (95% CI: 86-97%, I2 : 66.11%), respectively. The overall rates of polyp recurrence, appendicitis, and bleeding were 0.1% (95% CI: 0-2%, I2 : 0%), 3% (95% CI: 0-4%, I2 : 0%), and 1% (95% CI: 0-3%, I2 : 0%), respectively. Conversely, perforation exhibited a relatively high incidence of 11% (95% CI: 3-19%, I2 : 84.55%); however, the need for surgical intervention was 6% (95% CI: 1-10%, I2 : 74.12%).

Conclusion: ESD provides a safe and effective alternative to surgical resection for managing periappendiceal lesions.