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Comparative Clinical Outcomes of Various Colorectal Endoscopic Submucosal Dissection Techniques: A Systematic Review
Seung Min Hong1, Jung Won Lee2, Jae Hyun Kim3
1Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Traction-assisted endoscopic submucosal dissection (T-ESD) demonstrated superior efficacy and safety compared to other colorectal endoscopic submucosal dissection (ESD) techniques. This network meta-analysis highlights T-ESD as a promising advancement in minimally invasive colorectal procedures.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Endoscopic Procedures
Background:
- Conventional endoscopic submucosal dissection (C-ESD) has limitations.
- Traction-assisted (T-ESD), hybrid (H-ESD), pocket-creation (P-ESD), and underwater (U-ESD) techniques were developed to improve ESD outcomes.
- A comparative analysis of these colorectal ESD techniques is needed.
Purpose of the Study:
- To systematically review and compare the clinical outcomes of various colorectal endoscopic submucosal dissection (ESD) techniques.
- To evaluate the efficacy and safety of T-ESD, H-ESD, P-ESD, and U-ESD against C-ESD using network meta-analysis.
Main Methods:
- A systematic review and network meta-analysis of randomized controlled trials (RCTs) comparing colorectal ESD techniques.
- Included techniques: C-ESD, T-ESD, H-ESD, P-ESD, U-ESD.
- Outcomes assessed: procedure time, dissection speed, en bloc resection, complete resection, perforation, and delayed bleeding.
Main Results:
- Sixteen RCTs with 1,536 patients were analyzed.
- T-ESD showed significantly shorter procedure times and faster dissection speeds.
- T-ESD and P-ESD ranked higher for en bloc resection; U-ESD and T-ESD ranked higher for complete resection.
- T-ESD demonstrated the most favorable safety profile for perforation, while U-ESD was best for delayed bleeding.
Conclusions:
- Traction-assisted endoscopic submucosal dissection (T-ESD) appears superior across multiple efficacy and safety metrics.
- Underwater ESD (U-ESD) shows promise for complete resection and reduced delayed bleeding.
- Hybrid ESD (H-ESD) exhibited faster dissection but poorer resection and bleeding outcomes compared to conventional ESD.
