Comparative Clinical Outcomes of Various Colorectal Endoscopic Submucosal Dissection Techniques: A Systematic Review and Network Meta-Analysis
In brief
Traction-assisted ESD cuts procedure time by about 25 minutes and boosts en-bloc resection
In a network meta-analysis of 16 RCTs (1,536 patients), traction-assisted endoscopic submucosal dissection was about 25 minutes faster than conventional ESD and ranked highest for en-bloc and complete resection as well as lowest perforation risk. Underwater ESD also performed well for complete resection and bleeding, while hybrid ESD lagged on key efficacy and safety outcomes.
- Journal
- Gut and liver (Q1)
- Published
- 14 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Seung Min Hong, Jung Won Lee, Jae Hyun Kim, Hyun Jung Kim, Seun Ja Park, Byung Soo Kwan
- PMID
- 42596873
- DOI
- 10.5009/gnl250559
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 16 August 2026): Network meta-analysis of colorectal ESD techniques
Abstract
BACKGROUND/AIMS: Traction-assisted endoscopic submucosal dissection (T-ESD), hybrid ESD (H-ESD), pocket-creation method ESD (P-ESD), and underwater ESD (U-ESD) were introduced to overcome the limitations of conventional ESD (C-ESD). We conducted a systematic review and network meta-analysis to compare the clinical outcomes of different colorectal ESD techniques. METHODS: Randomized controlled trials (RCTs) comparing various ESD techniques (C-ESD, T-ESD, H-ESD, P-ESD, U-ESD) were included. Procedure time, dissection speed, en bloc resection, complete resection, perforation, and delayed bleeding were compared using network meta-analysis. RESULTS: Sixteen RCTs involving 1,536 patients were included. T-ESD had a shorter procedure time (mean difference [MD], -25.17; 95% confidence interval [CI], -34.09 to -16.24). Dissection speed was faster with T-ESD (MD, 6.19; 95% CI, 2.12 to 10.26; surface under the cumulative ranking curve [SUCRA], 74.6) and H-ESD had a high SUCRA (73.0) for dissection speed. Based on the SUCRA rankings, T-ESD (81.4) and P-ESD (55.8) ranked higher for en bloc resection, while U-ESD (74.5) and T-ESD (65.2) ranked higher for complete resection. H-ESD consistently ranked lower than C-ESD for en bloc resection (6.5), complete resection (23.3), and delayed bleeding (23.6) according to SUCRA values. Regarding safety outcomes, T-ESD showed the most favorable SUCRA ranking for perforation (73.6), and U-ESD showed the most favorable SUCRA ranking for delayed bleeding (74.9). CONCLUSIONS: T-ESD ranked higher according to SUCRA values across multiple efficacy and safety outcomes. U-ESD ranked favorably for complete resection and delayed bleeding based on SUCRA values. H-ESD had a higher SUCRA value for dissection speed but ranked lower for en bloc resection, complete resection, and delayed bleeding.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.