Comparison of EMR and ESD for early Barrett's neoplasia: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Aims Barrett's esophagus (BE) with visible lesions including high-grade dysplasia and esophageal adenocarcinoma is treated by endoscopic resection. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are both accepted strategies for resection of Barrett’s lesions. However, a lack of consensus exists regarding which technique offers superior clinical outcomes and safety. This study aims to compare the clinical outcomes and safety of EMR versus ESD in treating early Barrett's neoplasia and esophageal adenocarcinoma. Methods We searched 3 databases (Embase, MEDLINE, Cochrane Central) until October 1st, 2023. We included studies aimed at assessing the efficacy of EMR and ESD as treatment modalities for BE and esophageal adenocarcinoma. Our inclusive criteria encompassed randomized trials as well as observational studies. We focused on key outcome measures, namely, en bloc , R0 and curative resection rates, recurrence rates and adverse events rates. We performed meta-analyses on reported rates for en bloc , R0 and curative resection, and recurrence. Effect sizes were expressed as pooled Odds Ratio (OR) and 95% Confidence Intervals (CI) for resection and recurrence rates, and 95% Confidence Intervals (CI). Results Our search identified 905 records. We excluded 181 duplicates, screened 22 full texts and 724 abstracts from the total search. 15 studies were included in the final analyses. Data pooled from 11 studies showed significantly higher en bloc resection rates [OR=1.846 (95% CI: 1.567-2.125), 11 studies] with ESD. R0 resection rates from 10 studies were significantly higher with ESD [OR=1.58, (95% CI: 0.955-2.21), 10 studies]. Curative resection rates from 5 studies were significantly higher with ESD [OR=1.173 (95% CI: 0.066 – 2.280), 5 studies]. The local recurrence rates pooled from 10 studies were significantly higher with EMR [OR=0.941 (95% CI: 0.129-1.753), 10 studies]. Conclusions In a systematic review of studies comparing EMR and ESD for early Barrett's neoplasia, ESD achieves higher en bloc , R0 and curative resection rates, while EMR is associated with higher local recurrence rates. These results suggest that ESD may be a more effective option for managing early Barrett's neoplasia. [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] [ 7 ] [ 8 ] [ 9 ] [ 10 ] [ 11 ] [ 12 ] [ 13 ] PROSPERO: (CRD42023426486) Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.015 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.018 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".