Hybrid versus conventional endoscopic submucosal dissection for treatment of gastric lesions: a comparative systematic review and meta-analysis

TL;DR

This study compares hybrid and conventional endoscopic submucosal dissection for treating stomach lesions, finding that hybrid is faster but less effective in removing lesions completely.

Contribution

The study provides a meta-analysis comparing hybrid and conventional ESD techniques for gastric lesions, revealing differences in procedure time and resection rates.

Findings

Hybrid ESD had significantly shorter procedure times compared to conventional ESD.

Hybrid ESD was associated with lower en-bloc resection rates than conventional ESD.

Adverse event rates were similar between hybrid and conventional ESD.

Abstract

Hybrid endoscopic submucosal dissection (ESD) may overcome the complexity of conventional ESD associated with gastric lesions. The aim of this study was to perform a systematic review and meta-analysis to compare the efficacy and safety of hybrid versus conventional ESD for the treatment of gastric lesions.

Individualized search strategies were developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. Pooled proportions were calculated with rates estimated using random-effects models. Measured outcomes included en-bloc resection, procedure-associated adverse events, and procedure duration. Heterogeneity was assessed with the I2 statistic and publication bias using funnel plots and Egger regression testing.

Of 5 included comparator studies (hybrid ESD, 184 patients; conventional ESD, 289 patients), 1 was a randomized trial and 4 were retrospective observational studies. Mean patient age was 68.89 ± 4.75 years, and the average lesion size was 17.81 ± 5.58 mm. Hybrid ESD patients were older (P < .001) with smaller lesions (15.75 ± 4.72 mm vs 19.12 ± 5.69 mm; P < .001). Overall, the en-bloc resection rate was significantly decreased for hybrid ESD (odds ratio [OR], .11; 95% confidence interval [CI], .02-.62; P = .010). Total adverse events were not different between groups (OR, 1.56; 95% CI, .44-5.53; P = .490). Rates of delayed bleeding (OR, 1.47; 95% CI, .34-6.40; P = .610) and perforation (OR, 2.41; 95% CI, .65-9.12; P = .194) were also not significantly different. Procedure time was significantly shorter for hybrid ESD (mean difference, 15.13 minutes; 95% CI, 4.05-26.21; P = .007).

Although hybrid ESD for gastric lesions was associated with significantly shorter procedure times compared with conventional ESD, hybrid ESD was associated with lower rates of en-bloc resection and similar adverse events.

Figures