Conventional endoscopic submucosal dissection (ESD) versus hybrid ESD in patients with early gastric neoplasms: A Systematic Review and Meta-Analysis

Aims Performing conventional endoscopic submucosal dissection (C-ESD) is still challenging for gastric neoplasm. A novel technique known as hybrid endoscopic submucosal dissection (H-ESD) has proven to be both reliable and effective. This study aimed to compare H-ESD and C-ESD in a systematic review and meta-analysis. Methods We performed a systemic literature search of all related studies comparing the H-ESD and C-ESD in patients with early gastric cancer. Random-effects models were used to pool the data. En bloc resection rate, procedure time, complete resection rate, and adverse effects from the procedure were used to measure the success of the treatment. Results One randomized clinical trial and three observational studies involving 445 patients were enrolled in this mate-analysis. The en bloc rate for H-ESD and C-ESD groups was 99.2% and 100%, respectively (odds ratio (OR), 0.68; 95%CI: 0.03 to 17.92; p=0.82). The procedure time was shorter in H-ESD than in the C-ESD group (mean differences, -18.48 min; 95% CI, -31.46 to -5.5 min; p=0.005; I 2 =99%). The pooled OR of complete resection was 0.96 (95% CI: 0.23 to 4.09; p=0.96; I 2 =0%). There was no significant difference in perforation rate (OR, 1.11; 95%CI: 0.13 to 9.53; p=0.92; I 2 =0%) and delayed bleeding rate (OR, 0.30; 95%CI: 0.04 to 2.45; p=0.26; I 2 =0%). Conclusions Overall, H-ESD was superior to C-EMR for the procedure time with similar rates of en bloc, complete resection, or procedure-related complications. Publication History Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany