S2257 Safety and Efficacy of Hybrid Versus Conventional Endoscopic Submucosal Dissection for Removal of Gastrointestinal Lesions: A Meta-Analysis

Introduction: Endoscopic submucosal dissection (ESD) is an established method for en-bloc resection of large or complex gastrointestinal (GI) lesions. Conventional ESD (C-ESD) is technically demanding and time-intensive, leading to the development of hybrid ESD (H-ESD) to improve procedural ease and speed. This systematic review and meta-analysis compares the clinical outcomes between H-ESD and C-ESD. Methods: We searched PubMed, Scopus, Embase, Cochrane Library, ScienceDirect, and ClinicalTrials.gov for eligible studies. Meta-analysis was conducted using R software with random-effects models. Dichotomous outcomes were pooled as risk ratios (RRs) and continuous outcomes as mean differences (MDs), both with 95% confidence intervals (CIs) and a significance threshold of P < 0.05. Results: Thirty-eight studies (7,226 patients; 8,129 lesions) were included. H-ESD was associated with significantly lower en-bloc (RR = 0.91; 95% CI: 0.87-0.95; P < 0.001) and complete (R0) resection rates (RR = 0.94; 95% CI: 0.91-0.98; P = 0.005), higher local recurrence (RR = 3.03; 95% CI: 1.55-5.92; P = 0.001), but shorter procedure time (MD = −16.56 minutes; P < 0.01). There was no significant difference in intra-procedure bleeding (RR = 1.24; P = 0.388), intra-procedure perforation (RR = 0.96; P = 0.831), post-procedure bleeding (RR = 0.81; P = 0.439), and post-procedure perforation (RR = 0.63; P = 0.574). H-ESD showed no significant difference versus C-ESD in lateral margin involvement (P = 0.106), deep margin positivity (P = 0.265), or piecemeal resection rates (P = 0.185). In colorectal lesions, H-ESD showed lower en-bloc and complete resection rates vs C-ESD (P < 0.0001). Conclusion: In conclusion, H-ESD offers shorter procedure times for GI lesions with comparable efficacy in upper GI and small intestinal lesions but shows inferior outcomes in colorectal lesions. However, C-ESD is preferred for lesions >20 mm to achieve optimal oncological outcomes.