Hybrid endoscopic submucosal dissection reduces procedure time for superficial esophageal squamous carcinomas ≤ 2 cm:...

Conventional endoscopic submucosal dissection (C-ESD) for esophageal neoplastic lesions is challenging and time-consuming. Hybrid ESD (H-ESD) is a simplified ESD technique involving lesion marking, followed by circumferential incision and appropriate submucosal dissection, and, finally, lesions are resected using a single snare. Evidence regarding its use in esophageal cancer remains limited. In this single-center study, we aimed to compare the efficacy and safety of H-ESD with those of conventional ESD for superficial esophageal squamous carcinomas ≤2 cm.

We retrospectively reviewed patients with superficial esophageal squamous carcinomas who underwent ESD at our center between January 2022 and August 2025. The primary outcome was procedure time. The secondary outcomes included resection speed, R0 resection rate, en bloc resection rate, and incidence of adverse events.

A total of 381 patients were included. Following 1:2 propensity score matching, 25 and 50 patients were allocated to the H-ESD and C-ESD groups, respectively. The average procedure time in the H-ESD group was significantly shorter than that in the C-ESD group (9.44±5.78 min vs. 28.72±19.20 min, p<0.001). The resection speed was faster in the H-ESD group than in the C-ESD group (0.30±0.16 cm²/min vs. 0.20±0.12 cm²/min, p=0.002). Between the two groups, no significant differences were found in the en bloc resection rate, R0 resection rate, or adverse events. Although the incidence of muscular injury in the H-ESD group was lower (0% vs. 12%), the difference was not statistically significant (P = 0.176).

Compared with C-ESD, H-ESD is associated with shorter procedure time and faster resection speed. Therefore, H-ESD is an alternative endoscopic treatment for superficial esophageal squamous carcinomas ≤2 cm ESD.