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Comparative Efficacy and Safety of Hybrid Endoscopic Submucosal Dissection for Colorectal Neoplasia: A Systematic
Moaz Alowami1, Chitrala Sruthi2, Simona Sehrish3
1Libyan International Medical University Benghazi Libya.
Background:
Hybrid endoscopic submucosal dissection (h-ESD) has emerged as a modified approach to overcome the technical challenges associated with conventional ESD (c-ESD). However, evidence comparing their safety and efficacy in colorectal neoplasia remains limited.
Methods:
A comprehensive search was conducted in PubMed, Cochrane Library, and Embase up to April 2025 for randomized and propensity-matched studies comparing h-ESD with c-ESD for colorectal neoplasia. The primary outcome was en bloc resection, with secondary outcomes including procedure time, adverse events, bleeding, and perforation. Data synthesis was performed using a random-effects model in RevMan.
Results:
Five studies (three RCTs and two propensity-matched cohorts) involving 1047 participants were included. The pooled analysis demonstrated no significant differences in en bloc resection rates (OR = 0.64, 95% CI = 0.26-1.56; p = 0.33; I 2 = 69%) or R0 resection rates (OR = 0.70, 95% CI = 0.44-1.11; p = 0.13; I 2 = 24%). h-ESD was associated with significantly shorter procedure duration (WMD = -10.65 min, 95% CI: -14.90 to -6.39; p < 0.01; I 2 = 5%). No significant differences were observed for overall adverse events (OR = 1.14, 95% CI: 0.70-1.84), bleeding episodes (OR = 1.28, 95% CI: 0.45-3.65), or bowel perforation (OR = 0.97, 95% CI: 0.54-1.73).
Conclusion:
Hybrid ESD demonstrated equivalent safety and efficacy to c-ESD for colorectal neoplasia, with the added advantage of significantly shorter procedure times. Further high-quality RCTs are needed to validate its role in clinical practice.
