Efficacy and safety of underwater versus conventional endoscopic submucosal dissection for superficial gastrointestinal neoplasms: A systematic review and meta-analysis
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Underwater endoscopic submucosal dissection (UESD) was developed to facilitate the ESD technique. By utilizing a saline medium, UESD provides a floating effect and enhances visual magnification. This meta-analysis aimed to assess and compare the efficacy and safety of UESD with conventional ESD (CESD). Comparative clinical studies evaluating UESD and CESD were identified through electronic bibliographic searches. All study designs, including abstracts, were screened. Key outcomes included resection speed, procedure duration, en bloc and R0 resection rates, and the incidence of adverse events. Random-effects models were used to calculate pooled mean differences for continuous variables and risk ratios for categorical variables. Eight studies including 1,257 patients (UESD: 470; CESD: 787) were analyzed. The average lesion size was 22.8 ± 3.6 mm, with comparable baseline characteristics between groups. Pooled data demonstrated that UESD achieved a significantly faster resection speed, with a weighted mean difference of 4.02 mm2/min (95% confidence intervals [CI]: 2.75 to 5.30; P < 0.001; I2 = 0%), and reduced overall procedure times by a mean difference of –15.56 minutes (95% CI: –21.56 to –9.56; P < 0.001; I2 = 54%). En bloc and R0 resection rates were similar between the groups (risk ratio 1.00; 95% CI: 0.99 to 1.02; P = 0.65; I2 = 0%; and risk ratio 1.02; 95% CI: 0.99 to 1.04; P = 0.12; I2 = 0%, respectively). The rates of procedural abortion and adverse events, including perforations and post-polypectomy syndrome, were also comparable. UESD offers a markedly increased resection speed and shorter overall procedure time compared to CESD. This technique does not require additional equipment and is easily implementable, making it an ideal learning option for endoscopists specializing in ESD.
Abstract
Underwater endoscopic submucosal dissection (UESD) was developed to facilitate the ESD technique. By utilizing a saline medium, UESD provides a floating effect and enhances visual magnification. This meta-analysis aimed to assess and compare the efficacy and safety of UESD with conventional ESD (CESD). Comparative clinical studies evaluating UESD and CESD were identified through electronic bibliographic searches. All study designs, including abstracts, were screened. Key outcomes included resection speed, procedure duration, en bloc and R0 resection rates, and the incidence of adverse events. Random-effects models were used to calculate pooled mean differences for continuous variables and risk ratios for categorical variables. Eight studies including 1,257 patients (UESD: 470; CESD: 787) were analyzed. The average lesion size was 22.8 ± 3.6 mm, with comparable baseline characteristics between groups. Pooled data demonstrated that UESD achieved a significantly faster resection speed, with a weighted mean difference of 4.02 mm2/min (95% confidence intervals [CI]: 2.75 to 5.30; P < 0.001; I2 = 0%), and reduced overall procedure times by a mean difference of –15.56 minutes (95% CI: –21.56 to –9.56; P < 0.001; I2 = 54%). En bloc and R0 resection rates were similar between the groups (risk ratio 1.00; 95% CI: 0.99 to 1.02; P = 0.65; I2 = 0%; and risk ratio 1.02; 95% CI: 0.99 to 1.04; P = 0.12; I2 = 0%, respectively). The rates of procedural abortion and adverse events, including perforations and post-polypectomy syndrome, were also comparable. UESD offers a markedly increased resection speed and shorter overall procedure time compared to CESD. This technique does not require additional equipment and is easily implementable, making it an ideal learning option for endoscopists specializing in ESD.