# Comparative Efficacy and Safety of Hybrid Endoscopic Submucosal Dissection for Colorectal Neoplasia: A Systematic Review and Meta‐Analysis

## TL;DR

This study compares hybrid endoscopic submucosal dissection (h-ESD) with conventional ESD for colorectal neoplasia, finding similar safety and effectiveness but shorter procedure times with h-ESD.

## Contribution

The study introduces a meta-analysis comparing hybrid ESD with conventional ESD for colorectal neoplasia, highlighting procedure time differences.

## Key findings

- Hybrid ESD showed equivalent en bloc and R0 resection rates compared to conventional ESD.
- Procedure time was significantly shorter with hybrid ESD.
- No significant differences were found in adverse events, bleeding, or perforation rates.

## Abstract

Hybrid endoscopic submucosal dissection (h‐ESD) has emerged as a modified approach to overcome the technical challenges associated with conventional ESD (c‐ESD). However, evidence comparing their safety and efficacy in colorectal neoplasia remains limited.

A comprehensive search was conducted in PubMed, Cochrane Library, and Embase up to April 2025 for randomized and propensity‐matched studies comparing h‐ESD with c‐ESD for colorectal neoplasia. The primary outcome was en bloc resection, with secondary outcomes including procedure time, adverse events, bleeding, and perforation. Data synthesis was performed using a random‐effects model in RevMan.

Five studies (three RCTs and two propensity‐matched cohorts) involving 1047 participants were included. The pooled analysis demonstrated no significant differences in en bloc resection rates (OR = 0.64, 95% CI = 0.26–1.56; p = 0.33; I
2 = 69%) or R0 resection rates (OR = 0.70, 95% CI = 0.44–1.11; p = 0.13; I
2 = 24%). h‐ESD was associated with significantly shorter procedure duration (WMD = −10.65 min, 95% CI: −14.90 to −6.39; p < 0.01; I
2 = 5%). No significant differences were observed for overall adverse events (OR = 1.14, 95% CI: 0.70–1.84), bleeding episodes (OR = 1.28, 95% CI: 0.45–3.65), or bowel perforation (OR = 0.97, 95% CI: 0.54–1.73).

Hybrid ESD demonstrated equivalent safety and efficacy to c‐ESD for colorectal neoplasia, with the added advantage of significantly shorter procedure times. Further high‐quality RCTs are needed to validate its role in clinical practice.