Gastrointestinal endoscopy · 2025
Underwater versus traction-assisted endoscopic submucosal dissection for colorectal lesions: a network meta-analysis of randomized controlled trials.
СтатьяМетаанализСистематический обзорСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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de Sire Roberto, Spadaccini Marco, De Deo Diletta, Massimi Davide, Alfarone Ludovico, Capogreco Antonio, Facciorusso Antonio, Andrisani Gianluca, Sferrazza Sandro, Jacques Jeremie, Alkandari Asma, Bhandari Pradeep, Mori Yuichi, Hassan Cesare, Maselli Roberta, Repici Alessandro
Аннотация
BACKGROUND AND AIMS: Among the newly established endoscopic submucosal dissection (ESD) techniques, underwater ESD (UW-ESD) using saline solution and traction-assisted ESD (T-ESD) aim to address the limitations of conventional ESD (C-ESD) for the resection of colorectal lesions. However, their comparative efficacy and safety remain uncertain.
METHODS: A systematic review and network meta-analysis of randomized controlled trials was conducted to compare UW-ESD and T-ESD. Main outcomes included R0 resection, dissection speed, and adverse events (AEs). We conducted indirect comparisons between UW-ESD and T-ESD and direct comparisons with C-ESD. Results were presented as risk ratios (RR) and standard mean deviations (SMDs) with 95% confidence intervals (CIs).
RESULTS: Four RCTs including 543 ESDs (98 UW-ESDs, 171 T-ESDs, and 274 C-ESDs) were analyzed. For R0 resection, no significant difference was observed between UW-ESD and T-ESD (RR = 0.99; 95% CI, 0.92-1.07), and both were comparable to C-ESD (UW-ESD: RR = 1.02; 95% CI, 0.98-1.07; T-ESD: RR = 1.01; 95% CI, 0.96-1.07). Dissection speed was significantly higher with UW-ESD compared with both T-ESD (SMD = 0.36; 95% CI, 0.14-0.87) and C-ESD (SMD = 0.54; 95% CI, 0.15-0.92). No significant difference in AEs was observed between UW-ESD and T-ESD (RR = 1.80; 95% CI, 0.14-23.16), and both were comparable to C-ESD (UW-ESD: RR = 0.48; 95% CI, 0.06-4.15; T-ESD: RR = 0.86; 95% CI, 0.22-3.37).
CONCLUSIONS: UW-ESD and T-ESD are both effective and safe strategies for colorectal lesion resection; however, UW-ESD is the only technique that has demonstrated superior dissection speed.
METHODS: A systematic review and network meta-analysis of randomized controlled trials was conducted to compare UW-ESD and T-ESD. Main outcomes included R0 resection, dissection speed, and adverse events (AEs). We conducted indirect comparisons between UW-ESD and T-ESD and direct comparisons with C-ESD. Results were presented as risk ratios (RR) and standard mean deviations (SMDs) with 95% confidence intervals (CIs).
RESULTS: Four RCTs including 543 ESDs (98 UW-ESDs, 171 T-ESDs, and 274 C-ESDs) were analyzed. For R0 resection, no significant difference was observed between UW-ESD and T-ESD (RR = 0.99; 95% CI, 0.92-1.07), and both were comparable to C-ESD (UW-ESD: RR = 1.02; 95% CI, 0.98-1.07; T-ESD: RR = 1.01; 95% CI, 0.96-1.07). Dissection speed was significantly higher with UW-ESD compared with both T-ESD (SMD = 0.36; 95% CI, 0.14-0.87) and C-ESD (SMD = 0.54; 95% CI, 0.15-0.92). No significant difference in AEs was observed between UW-ESD and T-ESD (RR = 1.80; 95% CI, 0.14-23.16), and both were comparable to C-ESD (UW-ESD: RR = 0.48; 95% CI, 0.06-4.15; T-ESD: RR = 0.86; 95% CI, 0.22-3.37).
CONCLUSIONS: UW-ESD and T-ESD are both effective and safe strategies for colorectal lesion resection; however, UW-ESD is the only technique that has demonstrated superior dissection speed.