Endoscopic Submucosal Dissection for Locally Recurrent Gastric Neoplasia Following Endoscopic Resection: A Systematic Review and Meta-Analysis.

[BACKGROUND & AIMS] Endoscopic submucosal dissection (ESD) for locally recurrent gastric neoplasia following endoscopic resection (ER) is technically challenging because of scar-related submucosal fibrosis. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of salvage ESD in this setting.

[METHODS] Multiple databases were searched through December 2025 for studies reporting ESD outcomes for locally recurrent gastric lesions at or contiguous with a prior ER scar. Primary outcome was curative resection and need for surgery. Secondary outcomes were en bloc and R0 resection, local recurrence, delayed bleeding, and perforation. Meta-analyses were performed using a random effects model. Heterogeneity was assessed using I.

[RESULTS] Seven studies (259 patients; 265 ESDs) were included. Across five studies and 243 ESDs, pooled curative resection rate was 69.7% (95% CI, 60.6-78.1; I=38%), while 8.2% (95% CI: 3.3-14.6; I = 38.4%) required surgery. En bloc resection rate was 92.3% (95% CI, 79.1-99.7; I=83.7%) across six studies, and pooled R0 resection rate was 87.5% (95% CI, 82.1-92.2; I=0%) across four studies. Over a mean follow-up of 42 months, pooled local recurrence was 2.0% (95% CI, 0.0-9.7; I=54.1%) across six studies. Delayed bleeding was 4.1% (95% CI, 0.8-9.0; I=40.8%) and perforation was 4.1% (95% CI, 1.6-7.3; I=0%).

[CONCLUSIONS] ESD for locally recurrent gastric neoplasia after ER achieves acceptable curative resection, high en bloc/R0 resection, and low local recurrence and morbidity. It is a viable organ-preserving option for appropriately selected patients, ideally performed at expert centers with close surveillance.