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Updated: Aug 15, 2026
Evaluation of the Effectiveness of Longitudinal Incision for Endoscopic Submucosal Excavation of Gastric Subepithelial Lesions
Published on: April 28, 2026
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.
Background/Aims:
Traction-assisted endoscopic submucosal dissection (T-ESD), hybrid ESD (H-ESD), pocket-creation method ESD (P-ESD), and underwater ESD (U-ESD) were introduced to overcome the limitations of conventional ESD (C-ESD). We conducted a systematic review and network meta-analysis to compare the clinical outcomes of different colorectal ESD techniques.
Methods:
Randomized controlled trials (RCTs) comparing various ESD techniques (C-ESD, T-ESD, H-ESD, P-ESD, U-ESD) were included. Procedure time, dissection speed, en bloc resection, complete resection, perforation, and delayed bleeding were compared using network meta-analysis.
Results:
Sixteen RCTs involving 1,536 patients were included. T-ESD had a shorter procedure time (mean difference [MD], -25.17; 95% confidence interval [CI], -34.09 to -16.24). Dissection speed was faster with T-ESD (MD, 6.19; 95% CI, 2.12 to 10.26; surface under the cumulative ranking curve [SUCRA], 74.6) and H-ESD had a high SUCRA (73.0) for dissection speed. Based on the SUCRA rankings, T-ESD (81.4) and P-ESD (55.8) ranked higher for en bloc resection, while U-ESD (74.5) and T-ESD (65.2) ranked higher for complete resection. H-ESD consistently ranked lower than C-ESD for en bloc resection (6.5), complete resection (23.3), and delayed bleeding (23.6) according to SUCRA values. Regarding safety outcomes, T-ESD showed the most favorable SUCRA ranking for perforation (73.6), and U-ESD showed the most favorable SUCRA ranking for delayed bleeding (74.9).
Conclusions:
T-ESD ranked higher according to SUCRA values across multiple efficacy and safety outcomes. U-ESD ranked favorably for complete resection and delayed bleeding based on SUCRA values. H-ESD had a higher SUCRA value for dissection speed but ranked lower for en bloc resection, complete resection, and delayed bleeding.
