Endoscopy 2025; 57(S 02): S212
DOI: 10.1055/s-0045-1805521
Abstracts | ESGE Days 2025
Moderated poster
ESD – Everything you want to know! 03/04/2025, 16:00 – 17:00 Poster Dome 2 (P0)

Comparative efficacy of different techniques for colonic endoscopic submucosal dissection: a network meta-analysis of randomized controlled trials

Authors

  • M Maida

    1   Department of Medicine and Surgery, University of Enna ‘Kore’, Enna, Italy
    2   Gastroenterology Unit, Umberto I Hospital, Enna, Italy

  • A Facciorusso

    3   Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy

  • G Marasco

    4   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
    5   S. Orsola-Malpighi Polyclinic, Bologna, Italy

  • G Calabrese

    6   Gastroenterology and Endoscopy Unit, 'ARNAS Civico – Di Cristina – Benfratelli' Hospital, Palermo, Italy

  • G Ianiro

    7   Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, Rome, Italy

  • J Jacques

    8   Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France

  • R Maselli

    9   Endoscopy Unit, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Italy
    10   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy

  • C Hassan

    9   Endoscopy Unit, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Italy
    10   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy

  • A Repici

    9   Endoscopy Unit, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Italy
    10   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy

  • R Di Mitri

    6   Gastroenterology and Endoscopy Unit, 'ARNAS Civico – Di Cristina – Benfratelli' Hospital, Palermo, Italy

  • S Sferrazza

    6   Gastroenterology and Endoscopy Unit, 'ARNAS Civico – Di Cristina – Benfratelli' Hospital, Palermo, Italy
Further Information
Also available at
 

Aims Endoscopic submucosal dissection (ESD) is an advanced technique that can provide a successful ‘en-bloc’ and R0 resection rate for large gastrointestinal (GI) lesions. To date, several ESD techniques have been proposed, but their comparative efficacy is still unclear. Therefore, we conducted a systematic review and network meta-analysis aimed to compare the efficacy and safety of different techniques of ESD for resection of colonic lesions.

Methods MEDLINE, Embase, Scopus, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing the efficacy and safety of different ESD techniques for resection of colonic lesions. The primary outcomes were ‘en-bloc’ and R0 resection rates. The secondary outcome was the incidence of procedure-related AEs. Direct and indirect comparisons were performed among ESD techniques. Results were expressed as risk ratio (RR) and 95% confidence interval (CI).

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). On network meta-analysis for 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. Overall, P-ESD resulted the best technique for ‘en-bloc’ resection (SUCRA 0.70) and PT-ESD for R0 (SUCRA 0.83), while H-ESD showed the poorest performance for both outcomes (SUCRA 0.06 and 0.30, respectively).

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 avoided or reserved as a rescue treatment, preferring other techniques.



Publication History

Article published online:
27 March 2025

© 2025. European Society of Gastrointestinal Endoscopy. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany