Conventional Versus Traction-Assisted Endoscopic Submucosal Dissection for Esophageal Cancers: A Systematic Review and Meta-Analysis.

Endoscopic submucosal dissection (ESD) is widely used to treat esophageal cancer. Traction-assisted ESD (TA-ESD) has shown promising outcomes, potentially offering better clinical results than conventional ESD (C-ESD). This study compares the efficacy and safety of C-ESD versus TA-ESD in esophageal cancer treatment. We conducted a meta-analysis of six studies involving 694 patients comparing clinical outcomes between the two techniques. Mean dissection time was similar between TA-ESD and C-ESD (71.48 vs 72.02 minutes, p = 0.4). TA-ESD yielded a larger resected area (32.49 cm2 vs 25.05 cm2, p < 0.05). TA-ESD had higher curative resection rates, 52.5% (CI = 42.4-62.4; I2 = 97.8%), compared to C-ESD, 36.6% (CI = 25.4-49.5; I2 = 98.2%); RR 1.46 (CI = 1.15-1.84; p = 0.0018). En-bloc resection rates were 96.9% (CI = 90.9-98.7; I2 = 19.3%) and 96.8% (CI = 82.5-99.5; I2 = 74.6%) with TA-ESD and C-ESD, respectively; RR 1.01 (CI = 0.96-1.09; p = 0.68). R0 resection rates with TA-ESD and C-ESD were 86.6% (CI = 62.3-96.2; I2 = 89.5%) and 77.6% (CI = 42.9-94.1; I2 = 95%), respectively; RR 1.11 (CI = 0.81-1.51; p = 0.28). Total adverse events with TA-ESD and C-ESD were 0.9% (CI = 0.2-3.6; I2 = 0%) and 4.1% (CI = 2.0-8.2; I2 = 95.9%), respectively; RR 0.08 (CI = 0.004-1.36; p = 0.08). Stricture development was more common with TA-ESD, 35.4% (CI = 24.3-48.4; I2 = 96.1%), compared to C-ESD, 19.5% (CI = 11.3-31.6; I2 = 97.5%); RR 1.33 (CI = 1.08-1.65; p = 0.0079). Perforation rates were lower with TA-ESD, 2.0% (CI = 0.5-7.2; I2 = 51.9%), compared to C-ESD, 3.6% (CI = 0.7-17.2; I2 = 85%), with RR 0.55 (CI = 0.32-0.94; p = 0.03). TA-ESD demonstrated higher curative resection rates with larger resected area and lower perforation rates. However, it is associated with a higher risk of stricture formation. Further studies and cost-effective analysis are warranted to determine the optimal treatment approach.