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

Balloon-assisted endoscopic submucosal dissection (BA-ESD) can improve endoscopic maneuverability by stabilizing the tip of the scope. Studies have compared BA-ESD with conventional ESD (C-ESD) and reported conflicting results. We conducted a meta-analysis to compare BA-ESD with C-ESD in the management of colorectal polyps.

Several databases were reviewed from 1985 to December 16, 2024, to identify studies comparing BA-ESD with C-ESD for colorectal polyps. Our outcomes of interest were en bloc resection and R0 resection, procedure time, dissection speed, and adverse events such as perforation and bleeding. We calculated the pooled odds ratio (OR) with 95% CI for categorical variables and the standardized mean difference (SMD) with 95% CI for continuous variables.

We included 8 studies with 1449 patients (BA-ESD 420 and C-ESD 1029). We found no significant difference in the rate of en bloc resection, OR (95% CI): 1.00 (0.51-1.99) and R0 resection, OR (95% CI): 1.24 (0.51-3.02) between groups. We found no significant difference in bleeding and perforation between groups. We found no significant difference in procedure time, SMD (95% CI): -0.15 (-0.56 to 0.26) and dissection speed, SMD (95% CI): 0.18 (-0.28 to 0.63) between groups. Subgroup analysis of RCTs showed that the procedure time was significantly shorter in the BA-ESD group.

Our meta-analysis demonstrated comparable outcomes between BA-ESD and C-ESD, although analysis of RCTs demonstrated shorter procedure time with BA-ESD. Large-scale multicenter RCTs are required to further evaluate these findings.