Abstract
Introduction: Upper Gastrointestinal (GI) sub-epithelial tumors (SETs) can arise from any layer of the gastrointestinal tract and are mostly found during an endoscopy. Endoscopic Ultrasound guided fine-needle aspiration and biopsy (EUS-FNA)/EUS-FNB) has been conventionally used for tissue diagnosis. However, it's utility may be limited due to inadequate tissue sampling. Deep Biopsy (DB) via Endoscopic Submucosal Dissection (ESD) is emerging as an alternative technique to EUS-FNA/EUS-FNB with increased diagnostic yield of upper GI SETs. The evidence is based on observational studies as randomized control trials are lacking. Thus, we conducted this 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) reporting DB via ESD technique for diagnosis of upper GI SETs. Primary outcome of interest was overall diagnostic yield of the DB via ESD for upper GI SETs. Secondary outcome was to study complications in terms of perforation and major bleeding. Major bleeding was defined as bleeding requiring blood transfusion or endoscopic intervention. The meta-analysis was performed using Der Simonian and Laird random effect model. Results: Total of 8 studies comprising of 227 patients (106 males and 127 females) with mean age of 57 years were included in the final meta-analysis. The mean tumor size was 18.5 mm (95% CI = 16.5-20.6), I2 = 30.82%. Upper GI SETs were mainly located in the stomach (96.41%, 95% CI = 86.50-100.0, I2 = 82.61%). The overall pooled diagnostic yield of DB via ESD for upper GI SETs was 95.80% (95% CI = 87.21-100.00), I2 = 76.37% (figure1). Overall, major bleeding and perforation in our meta-analysis was noted in 0.06% (95% CI = 0.00-2.07, I2 =0%) and 0% (95% CI =0.00-1.54, I2 = 0%) respectively. Data regarding major bleeding and perforation rates was not reported in two studies. Significant heterogeneity was observed in our meta-analysis. Conclusion: DB via ESD is an effective and safe procedure for diagnosing upper GI SETs with an overall diagnostic yield of 95.80% and minimal adverse events (major bleeding and perforation). Multi-center randomized control trials are needed to further validate these findings.