Balloon-Assisted Versus Conventional Endoscopic Submucosal Dissection for Management of Large Colorectal Polyps: A...

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Prevention

Background:

• Balloon-assisted endoscopic submucosal dissection (BA-ESD) enhances scope maneuverability by stabilizing the endoscope tip.
• Existing studies comparing BA-ESD with conventional endoscopic submucosal dissection (C-ESD) have yielded conflicting results regarding efficacy and safety.
• A meta-analysis was conducted to systematically evaluate the comparative performance of BA-ESD and C-ESD in managing colorectal polyps.

Purpose of the Study:

• To compare the effectiveness and safety of BA-ESD versus C-ESD for colorectal polyp management.
• To analyze key outcomes including en bloc resection, R0 resection rates, procedure duration, and adverse events.
• To synthesize evidence from existing studies to inform clinical practice and future research directions.

Main Methods:

• A comprehensive literature search of multiple databases was performed from 1985 to December 2024.
• Included studies directly compared BA-ESD and C-ESD for colorectal polyp resection.
• Outcomes analyzed included en bloc and R0 resection rates, procedure time, dissection speed, and adverse events (perforation, bleeding).
• Pooled odds ratios (OR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated.

Main Results:

• Eight studies involving 1449 patients (420 BA-ESD, 1029 C-ESD) were included in the meta-analysis.
• No significant differences were observed in en bloc resection (OR: 1.00; 95% CI: 0.51-1.99) or R0 resection (OR: 1.24; 95% CI: 0.51-3.02) rates between the two techniques.
• Bleeding, perforation, procedure time (SMD: -0.15; 95% CI: -0.56 to 0.26), and dissection speed (SMD: 0.18; 95% CI: -0.28 to 0.63) showed no significant differences.
• Subgroup analysis of randomized controlled trials (RCTs) revealed a significantly shorter procedure time for BA-ESD.

Conclusions:

• The meta-analysis indicates that BA-ESD and C-ESD achieve comparable outcomes in terms of resection quality and safety for colorectal polyps.
• A notable finding from the subgroup analysis of RCTs suggests that BA-ESD may offer a procedural time advantage.
• Further large-scale, multicenter randomized controlled trials are warranted to definitively establish the benefits and optimal application of BA-ESD.