Hybrid endoscopic submucosal dissection (ESD) compared with conventional ESD for colorectal lesions: a systematic review and meta-analysis

Abstract

Background Hybrid endoscopic submucosal dissection (ESD) is increasingly utilized to overcome the complexity of conventional ESD. This systematic review and meta-analysis evaluated the efficacy and safety of hybrid ESD for treatment of colorectal lesions.

Methods Search strategies were developed in accordance with PRISMA guidelines. Pooled proportions were calculated with rates estimated using random effects models. Measured outcomes included en bloc resection, procedure-associated complications, recurrence, and need for surgery. Subgroup analyses were performed to compare effectiveness of conventional versus hybrid ESD.

Results 16 studies (751 patients) were included with a mean (standard deviation [SD]) lesion size of 27.96 (10.55) mm. En bloc resection rate was 81.63 % (95 % confidence interval [CI] 72.07 – 88.44; I²  = 80.89). Complications, recurrences, and need for surgery occurred in 7.74 % (95 %CI 4.78 – 12.31; I²  = 65.84), 4.52 % (95 %CI 1.40 – 13.65; I²  = 76.81), and 3.64 % (95 %CI 1.76 – 7.37; I²  = 15.52), respectively. Mean procedure duration was 48.83 (22.37) minutes. On subgroup analyses comparing outcomes for conventional (n = 1703) versus hybrid ESD (n = 497), procedure duration was significantly shorter for hybrid ESD (mean difference 18.45 minutes; P = 0.003), with lower complication rates (P = 0.04); however, hybrid ESD had lower en bloc resection rates (P < 0.001). There was no difference in rates of recurrence or surgery (P > 0.05).

Conclusion While hybrid ESD was safe and effective for removal of colorectal lesions, with shorter procedure duration, fewer complications, and no difference in recurrence versus conventional ESD, hybrid ESD was associated with a lower en bloc resection rate.

Publication History

Received: 29 March 2020

Accepted after revision: 18 September 2020

Accepted Manuscript online:
18 September 2020

Article published online:
16 December 2020

• References

• 1 McCarty TR, Aihara H. Current state of education and training for endoscopic submucosal dissection: translating strategy and success to the USA. Dig Endosc 2019;
• 2 Maple JT, Abu DayyehBK. ASGE Technology Committee. et al. Endoscopic submucosal dissection. Gastrointest Endosc 2015; 81: 1311-1325
• 3 McCarty TR, Bazarbashi AN, Hathorn KE. et al. Endoscopic submucosal dissection (ESD) versus transanal endoscopic microsurgery (TEM) for treatment of rectal tumors: a comparative systematic review and meta-analysis. Surg Endosc 2020; 34: 1688-1695
• 4 Nam MJ, Sohn DK, Hong CW. et al. Cost comparison between endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumors. Ann Surg Treat Res 2015; 89: 202-207
• 5 Park HW, Byeon JS, Park YS. et al. Endoscopic submucosal dissection for treatment of rectal carcinoid tumors. Gastrointest Endosc 2010; 72: 143-149
• 6 Park SU, Min YW, Shin JU. et al. Endoscopic submucosal dissection or transanal endoscopic microsurgery for nonpolypoid rectal high grade dysplasia and submucosa-invading rectal cancer. Endoscopy 2012; 44: 1031-1036
• 7 Fuccio L, Hassan C, Ponchon T. et al. Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 74-86
• 8 Pimentel-Nunes P, Pioche M, Albeniz E. et al. Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2019; 51: 980-992
• 9 Tanaka S, Kashida H, Saito Y. et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2020; 32: 219-239
• 10 Draganov PV, Wang AY, Othman MO. et al. AGA Institute Clinical Practice Update: Endoscopic submucosal dissection in the United States. Clin Gastroenterol Hepatol 2019; 17: 16-25
• 11 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297
• 12 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 2009; 151: W65-94
• 13 Turiani Hourneaux de Moura D, Aihara H, Jirapinyo P. et al. Robot-assisted endoscopic submucosal dissection versus conventional ESD for colorectal lesions: outcomes of a randomized pilot study in endoscopists without prior ESD experience (with video). Gastrointest Endosc 2019; 90: 290-298
• 14 Peery AF, Cools KS, Strassle PD. et al. Increasing rates of surgery for patients with nonmalignant colorectal polyps in the United States. Gastroenterology 2018; 154: 1352-1360
• 15 Goda K, Fujishiro M, Hirasawa K. et al. How to teach and learn endoscopic submucosal dissection for upper gastrointestinal neoplasm in Japan. Dig Endosc 2012; 24 (Suppl. 01) 136-142
• 16 Gotoda T, Draganov PV. ESD training in the East. In: Fukami N. Endoscopic submucosal dissection: principles and practice. New York, NY: Springer; 2015: 229-235
• 17 Ohata K, Muramoto T, Minato Y. et al. Usefulness of a multifunctional snare designed for colorectal hybrid endoscopic submucosal dissection (with video). Endosc Int Open 2018; 6: E249-E53
• 18 Yang D, Draganov PV. Gaining traction: pulley-ing your weight during endoscopic submucosal dissection. Gastrointest Endosc 2019; 89: 185-187
• 19 Sano Y, Tanaka S, Kudo SE. et al. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Dig Endosc 2016; 28: 526-533
• 20 Draganov PV, Gotoda T, Chavalitdhamrong D. et al. Techniques of endoscopic submucosal dissection: application for the Western endoscopist?. Gastrointest Endosc 2013; 78: 677-688
• 21 Rex DK, Hassan C, Dewitt JM. Colorectal endoscopic submucosal dissection in the United States: why do we hear so much about it and do so little of it?. Gastrointest Endosc 2017; 85: 554-558
• 22 Boskoski I, Costamagna G. Endoscopy robotics: current and future applications. Dig Endosc 2019; 31: 119-124
• 23 Yeung BP, Chiu PW. Application of robotics in gastrointestinal endoscopy: a review. World J Gastroenterol 2016; 22: 1811-1825
• 24 Yamamoto Y, Fujisaki J, Ishiyama A. et al. Current status of training for endoscopic submucosal dissection for gastric epithelial neoplasm at Cancer Institute Hospital, Japanese Foundation for Cancer Research, a famous Japanese hospital. Dig Endosc 2012; 24 (Suppl. 01) 148-153
• 25 Colon Cancer (version 2.2018). NCCN Clinical Practice Guidelines in Oncology. 2018 https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf Accessed 15 January 2020
• 26 Rectal Cancer (version 1.2018). NCCN Clinical Practice Guidelines in Oncology. 2018 https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf Accessed 15 January 2020
• 27 Toyonaga T, Man IM, Morita Y. et al. Endoscopic submucosal dissection (ESD) versus simplified/hybrid ESD. Gastrointest Endosc Clin N Am 2014; 24: 191-199
• 28 Gorospe EC, Wong Kee Song LM. Hybrid endoscopic submucosal dissection in the colon: cutting corners or trimming fat?. Gastrointest Endosc 2016; 83: 593-595
• 29 Ge PS, Jirapinyo P, Ohya TR. et al. Predicting outcomes in colorectal endoscopic submucosal dissection: a United States experience. Surg Endosc 2019; 33: 4016-4025
• 30 Yang D, Aihara H, Perbtani YB. et al. Safety and efficacy of endoscopic submucosal dissection for rectal neoplasia: a multicenter North American experience. Endosc Int Open 2019; 7: E1714-E1722
• 31 Gotoda T, Kaltenbach T, Soetikno R. Is en bloc resection essential for endoscopic resection of GI neoplasia?. Gastrointest Endosc 2008; 67: 805-807
• 32 Okamoto K, Muguruma N, Kagemoto K. et al. Efficacy of hybrid endoscopic submucosal dissection (ESD) as a rescue treatment in difficult colorectal ESD cases. Dig Endosc 2017; 29 (Suppl. 02) 45-52
• 33 Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med 2000; 342: 1887-1892