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.
