Abstract：
OBJECTIVE: As global life expectancy rises and gastrointestinal tumor incidence increases, more elderly patients are undergoing endoscopic submucosal dissection (ESD) for tumor treatment. The current situation highlights the importance of sarcopenia assessment before ESD. This systematic review and meta-analysis aim to assess sarcopenia\'s role in predicting post-ESD adverse outcomes in the elderly.
METHODS: We conducted a systematic review and meta-analysis to investigate the impact of sarcopenia on the prognosis of elderly patients undergoing ESD treatment. A comprehensive search was conducted across three databases (PubMed, Embase, Web of Science). We were using NEWCASTLE-OTTAWA ASSESSMENT SCALE for risk of bias assessment. The data were synthesized using Review Manager 5.3.
RESULTS: A total of 9 reports were identified, analyzing 7 indicators, with a combined sample size of 6044. Through a series of analyses, we have derived several highly credible research findings: the overall OR and 95% CI for gastric and colorectal post-ESD perforation between sarcopenia and nonsarcopenia groups were 1.34 [0.92, 1.97], for CTCAE grade > 2 was 2.65 [1.45, 4.82], for upper gastrointestinal post-ESD pneumonia were 1.97 [1.30, 2.99], and for gastric post-ESD mortality within 5 years were 2.96 [1.33, 6.58].
CONCLUSIONS: Sarcopenia is a risk factor for increased incidence of complications (CTCAE > 2) after undergoing gastric and colorectal ESD, increased pneumonia rates, and higher mortality rates within five years following gastric ESD treatment in elderly patients. However, sarcopenia does not lead to an increased perforation rate in elderly patients undergoing gastric and colorectal ESD treatments. Registration and protocol: The protocol for this study was registered on the Open Science Framework in 2024 https://doi.org/10.17605/OSF.IO/7B2CZ . We also conducted pre-registration on PROSPERO (CRD42024532547).
METHODS: We conducted a systematic review and meta-analysis to investigate the impact of sarcopenia on the prognosis of elderly patients undergoing ESD treatment. A comprehensive search was conducted across three databases (PubMed, Embase, Web of Science). We were using NEWCASTLE-OTTAWA ASSESSMENT SCALE for risk of bias assessment. The data were synthesized using Review Manager 5.3.
RESULTS: A total of 9 reports were identified, analyzing 7 indicators, with a combined sample size of 6044. Through a series of analyses, we have derived several highly credible research findings: the overall OR and 95% CI for gastric and colorectal post-ESD perforation between sarcopenia and nonsarcopenia groups were 1.34 [0.92, 1.97], for CTCAE grade > 2 was 2.65 [1.45, 4.82], for upper gastrointestinal post-ESD pneumonia were 1.97 [1.30, 2.99], and for gastric post-ESD mortality within 5 years were 2.96 [1.33, 6.58].
CONCLUSIONS: Sarcopenia is a risk factor for increased incidence of complications (CTCAE > 2) after undergoing gastric and colorectal ESD, increased pneumonia rates, and higher mortality rates within five years following gastric ESD treatment in elderly patients. However, sarcopenia does not lead to an increased perforation rate in elderly patients undergoing gastric and colorectal ESD treatments. Registration and protocol: The protocol for this study was registered on the Open Science Framework in 2024 https://doi.org/10.17605/OSF.IO/7B2CZ . We also conducted pre-registration on PROSPERO (CRD42024532547).
摘要：
目标：随着全球预期寿命的增加和胃肠道肿瘤发病率的增加，更多的老年患者正在接受内镜黏膜下剥离术(ESD)治疗肿瘤.目前的情况突出了在ESD之前进行肌少症评估的重要性。本系统评价和荟萃分析旨在评估肌少症在预测老年人ESD后不良结局中的作用。
方法：我们进行了系统评价和荟萃分析，以探讨肌少症对接受ESD治疗的老年患者预后的影响。在三个数据库(PubMed，Embase,WebofScience）。我们使用NEWCASTLE-OTTAWA评估量表进行偏倚风险评估。使用ReviewManager5.3合成数据。
结果：共确定9份报告，分析7个指标，合并样本量为6044。通过一系列的分析,我们得出了几个高度可信的研究结果：肌少症组和非肌少症组胃和结直肠ESD后穿孔的总体OR和95%CI为1.34[0.92,1.97]，CTCAE等级>2为2.65[1.45，4.82]，ESD后上消化道肺炎为1.97[1.30，2.99]，胃ESD术后5年内死亡率为2.96[1.33,6.58].
结论：肌肉减少症是胃和结直肠ESD术后并发症(CTCAE>2)发生率增加的危险因素，肺炎发病率增加，老年患者胃ESD治疗后5年内死亡率较高。然而,在接受胃和结直肠ESD治疗的老年患者中，肌少症不会导致穿孔率增加。注册和协议：本研究的协议于2024年在开放科学框架上注册https://doi.org/10.17605/OSF。IO/7B2CZ。我们还对PROSPERO(CRD42024532547)进行了预注册。
方法：我们进行了系统评价和荟萃分析，以探讨肌少症对接受ESD治疗的老年患者预后的影响。在三个数据库(PubMed，Embase,WebofScience）。我们使用NEWCASTLE-OTTAWA评估量表进行偏倚风险评估。使用ReviewManager5.3合成数据。
结果：共确定9份报告，分析7个指标，合并样本量为6044。通过一系列的分析,我们得出了几个高度可信的研究结果：肌少症组和非肌少症组胃和结直肠ESD后穿孔的总体OR和95%CI为1.34[0.92,1.97]，CTCAE等级>2为2.65[1.45，4.82]，ESD后上消化道肺炎为1.97[1.30，2.99]，胃ESD术后5年内死亡率为2.96[1.33,6.58].
结论：肌肉减少症是胃和结直肠ESD术后并发症(CTCAE>2)发生率增加的危险因素，肺炎发病率增加，老年患者胃ESD治疗后5年内死亡率较高。然而,在接受胃和结直肠ESD治疗的老年患者中，肌少症不会导致穿孔率增加。注册和协议：本研究的协议于2024年在开放科学框架上注册https://doi.org/10.17605/OSF。IO/7B2CZ。我们还对PROSPERO(CRD42024532547)进行了预注册。
