Safety and efficacy of hybrid versus conventional endoscopic submucosal dissection for removal of gastrointestinal lesions: A meta-analysis

Abstract

Endoscopic submucosal dissection (ESD) is an established technique for en bloc resection of large or complex gastrointestinal lesions. Conventional ESD (C-ESD) is technically challenging and time-consuming, which has led to the development of hybrid ESD (H-ESD) to facilitate the procedure and reduce duration. This systematic review and meta-analysis compared the clinical outcomes of H-ESD versus C-ESD. We systematically searched PubMed, Scopus, Embase, Cochrane Library, ScienceDirect, and ClinicalTrials.gov for eligible studies. Meta-analyses were conducted using R software with random-effects models. Dichotomous outcomes were pooled as risk ratios (RRs) and continuous outcomes as mean differences (MDs), both reported with 95% confidence intervals (CIs) and a significance threshold of P < 0.05. Thirty-eight studies (7,226 patients; 8,129 lesions) met the inclusion criteria. H-ESD was associated with significantly lower en bloc resection rates (RR = 0.91; 95% CI: 0.87–0.95; P < 0.001) and complete (R0) resection rates (RR = 0.94; 95% CI: 0.91–0.98; P = 0.005), as well as a higher risk of local recurrence (RR = 3.03; 95% CI: 1.55–5.92; P = 0.001), but a shorter procedure time (MD = –16.56 minutes; P < 0.01). There were no significant differences in intra-procedure bleeding (RR = 1.24; P = 0.388), intra-procedure perforation (RR = 0.96; P = 0.831), post-procedure bleeding (RR = 0.81; P = 0.439), or post-procedure perforation (RR = 0.63; P = 0.574). In colorectal lesions, H-ESD demonstrated lower en bloc and complete resection rates compared to C-ESD (P < 0.0001). In conclusion, although HESD is associated with shorter procedure times, it yields inferior oncologic outcomes, including lower R0 resection rates and higher local recurrence, particularly for colorectal lesions. C-ESD remains preferred for lesions > 20 mm and when optimal curative resection is essential.