Background: Traditional endoscopic submucosal dissection (ESD) has developed different methods, such as pocket method(P-ESD), traction-assisted method(T-ESD) and Hybrid method(H-ESD). In this meta-analysis, the benefits and drawbacks of different ESD methods were discussed and ranked.
Study design: Studies comparing different methods of colorectal ESD were searched by PubMed, Embase, and Cochrane Library databases. The study was conducted for five endpoints: en bloc resection rate, R0 resection rate, operation time, dissection speed, and adverse events rate. Pairwise and network meta-analyses were performed through Rev Man 5.4 and Stata 16.0. The quality of all included studies was assessed using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale.
Results: Twenty-six studies met the inclusion criteria, including 7 RCTs and 19 non-RCTs, with a total of 3002 patients. The pooled analysis showed that the en bloc resection rate of H-ESD was significantly lower than C-ESD, P-ESD and T-ESD [RR=0.28, 95%CI (0.12, 0.65); RR = 0.11, 95% CI (0.03, 0.44); RR = 8.28, 95% CI (2.50, 27.42)]. Compared with C-ESD, the operation time of H-ESD and T-ESD was significantly shorter [MD=-21.83, 95%CI (-34.76, -8.90); MD=-23.8, 95%CI (-32.55, -15.06)]. Meanwhile, the operation time of T-ESD was also significantly shorter than P-ESD [MD=-18.74, 95%CI (-31.93, -5.54)]. The dissection speed of T-ESD was significantly faster than C-ESD [MD=6.26, 95%CI (2.29, 10.23)].
Conclusion: P-ESD and T-ESD are probably the two best methods of colorectal ESD at present. The advantages of P-ESD are high en bloc resection rate and low incidence of adverse events. The advantages of T-ESD are rapid dissection and short operation time.
Colorectal endoscopic submucosal dissection: a systematic review and meta-analysis
