Relationship Between Helicobacter Pylori And Postoperative Complications Of Gastric Endoscopic Submucosal Dissection:a Meta-analysis

Objective:To systematically evaluate the relationship between Helicobacter Pylori(Hp)infection and eradication therapy and complications occurring that are iatrogenic ulcer,delayed bleeding,delayed perforation and postoperative stenosis after gastric Endoscopic Submucosal Dissection(ESD).Methods:We searched on the Pubmed,Embase,Cochrane Library,Web of science,CNKI,Wanfang Data,VIP,CBM,and included the literatures that meet the standard from the establishment of the database until February 29,2020,extracted the data and evaluted literature quality,and then used the Rev Man 5.3 software to perform the Meta-analysis and used the Stata 12.0 software to perform the publication bias test.Results:A total of 447 papers were retrieved,and 14 papers were included.There was no literatures on the relationship between HP infection and eradication therapy and delayed perforation and postoperative stenosis after gastric ESD.Result of Meta-analysis:(1)HP infection can reduce the healing rate of ulcer within 4 weeks after ESD(RR=0.56,95% CI:0.60~0.97,P<0.05),but it was not associated with ulcer healing after ESD 8weeks(RR=0.96,95%CI:0.89~1.03,P>0.05);(2)Combined HP eradication can increase the healing rate of ulcer after ESD(RR=1.22,95%CI:1.02~1.46,P<0.05),subgroup analysis result is when treatment duration of 4 weeks(RR=1.48,95%CI:1.08~2.02),maximum ulcer diameter>40mm(RR=1.77,95%CI:1.43~2.19)and quadruple therapy plan(RR=1.77,95%CI:1.43~2.19)can increase the healing rate of ulcer after ESD 8weeks(P<0.05);(3)HP infection and eradication therapy were not associated with delayed bleeding after ESD(P>0.05);(4)Publication bias test: Both Begg’s test and Egger’s test showed no publication bias(P>0.05).Conclusion:The current evidence shows that HP infection can reduce the healing rate of ulcer within 4 weeks after gastric ESD,and HP eradication therapy can improve the healing rate of ulcer after gastric ESD,in addition to,Hp infection and eradication therapy were not associated with delayed bleeding after gastric ESD,whether Hp infection and eradication treatment are related to delayed perforation and stenosis after gastric ESD needs further research to confirm.