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

作者：Marcello Maida, Antonio Facciorusso, G Marasco, Giulio Calabrese, Gianluca Ianiro, Jérémie Jacques, Roberta Maselli, Cesare Hassan, Alessandro Repici, Roberto Di Mitri, Sandro Sferrazza · 发表于：Endoscopy · 年份：2025 · DOI：10.1055/s-0045-1805521 · 被引用次数：4 · 研究领域：Gastric Cancer Management and Outcomes、Metastasis and carcinoma case studies、Gastrointestinal Tumor Research and Treatment

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. Overa...