Background: Endoscopic submucosal dissection (ESD) is an advanced technique that can provide successful ‘en-bloc’ and R0 resection rate for large gastrointestinal lesions. To date, several ESD techniques have been proposed, but their comparative efficacy is still unclear. Methods: Major databases were systematically searched for RCTs comparing the efficacy and safety of different ESD techniques for the resection of colonic lesions. The primary outcomes were ‘en-bloc’ and R0 resection rates. The secondary outcome was the incidence of procedure-related AEs. Results: After selection of studies, 9 RCTs were included in the systematic review. On network meta-analysis for ‘en-bloc’ resection, pocked with traction ESD (PT-ESD) (RR=1.02; 95%CI=0.96–1.07) and pocket ESD (P-ESD) (RR=1.02; 95%CI=0.98–1.05) showed higher efficacy, whereas hybrid ESD (H-ESD) (RR=0.94; 95%CI=0.87–1.02) lower efficacy compared to conventional ESD (C-ESD). With regard to R0 resection, PT-ESD (RR=1.05; 95%CI=0.96–1.16) showed higher efficacy, and H-ESD (RR=0.97; 95%CI=0.84–1.13) lower efficacy compared to C-ESD. Concerning safety PT-ESD (RR=0.35; 95%CI=0.05–2.48) was associated with lower incidence of AEs, and H-ESD (RR=1.22; 95%CI=0.30–5.01) with higher incidence of AEs, compared to C-ESD. Conclusions: The results of this network meta-analysis show a trend towards greater effectiveness and safety of PT-ESD for the removal of colonic lesions. H-ESD was associated with worse results and should be reserved as a rescue treatment, preferring other techniques.
Maida, M., Facciorusso, A., Marasco, G., Calabrese, G., Ianiro, G., Jacques, J., Maselli, R., Hassan, C., Repici, A., Mitri, R. D., Sferrazza, S., Comparative efficacy of different techniques for colonic endoscopic submucosal dissection: A network meta-analysis of randomized controlled trials, <<DIGESTIVE AND LIVER DISEASE>>, 2025; (N/A): N/A-N/A. [doi:10.1016/j.dld.2025.01.177] [https://hdl.handle.net/10807/310870]
Comparative efficacy of different techniques for colonic endoscopic submucosal dissection: A network meta-analysis of randomized controlled trials
Ianiro, Gianluca;Hassan, Cesare;Sferrazza, Silvia
2025
Abstract
Background: Endoscopic submucosal dissection (ESD) is an advanced technique that can provide successful ‘en-bloc’ and R0 resection rate for large gastrointestinal lesions. To date, several ESD techniques have been proposed, but their comparative efficacy is still unclear. Methods: Major databases were systematically searched for RCTs comparing the efficacy and safety of different ESD techniques for the resection of colonic lesions. The primary outcomes were ‘en-bloc’ and R0 resection rates. The secondary outcome was the incidence of procedure-related AEs. Results: After selection of studies, 9 RCTs were included in the systematic review. On network meta-analysis for ‘en-bloc’ resection, pocked with traction ESD (PT-ESD) (RR=1.02; 95%CI=0.96–1.07) and pocket ESD (P-ESD) (RR=1.02; 95%CI=0.98–1.05) showed higher efficacy, whereas hybrid ESD (H-ESD) (RR=0.94; 95%CI=0.87–1.02) lower efficacy compared to conventional ESD (C-ESD). With regard to R0 resection, PT-ESD (RR=1.05; 95%CI=0.96–1.16) showed higher efficacy, and H-ESD (RR=0.97; 95%CI=0.84–1.13) lower efficacy compared to C-ESD. Concerning safety PT-ESD (RR=0.35; 95%CI=0.05–2.48) was associated with lower incidence of AEs, and H-ESD (RR=1.22; 95%CI=0.30–5.01) with higher incidence of AEs, compared to C-ESD. Conclusions: The results of this network meta-analysis show a trend towards greater effectiveness and safety of PT-ESD for the removal of colonic lesions. H-ESD was associated with worse results and should be reserved as a rescue treatment, preferring other techniques.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.