Hybrid endoscopic submucosal dissection enhances efficiency with comparable curative outcomes: a Bayesian meta-analysis, systematic review, and Monte Carlo simulation of randomized controlled trials
In brief
Hybrid endoscopic submucosal dissection cuts procedure time by about 18 minutes without lowering cure rates
In a Bayesian meta-analysis of randomized trials, hybrid ESD achieved en bloc and R0 resection rates essentially identical to conventional ESD, while shaving roughly 18 minutes off the average procedure time. Adverse events and perforation rates were comparable. Larger studies are still needed to confirm long-term safety and efficacy.
- Journal
- Clinical endoscopy (Q2)
- Published
- 22 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Ashesh Das, Arpitha Sirichandana Baggu, Param Darpan Sheth, Nihal Reddy Bandi, Chandana Priya Digumurthy, Urvashi Bharia, et al.
- PMID
- 42770231
- DOI
- 10.5946/ce.2025.439
Why clinicians should know about it
- Picked for Medical Physics (top studies of the week, 27 September 2026).
Abstract
BACKGROUND/AIMS: Gastrointestinal (GI) cancers accounted for 3.24 million deaths worldwide in 2022. Endoscopic submucosal dissection (ESD) enables en bloc resection of early neoplasms but is time-intensive and technically challenging. Hybrid ESD (H-ESD), which combines dissection with snare polypectomy, may improve efficiency while maintaining efficacy.This Bayesian meta-analysis of randomized controlled trials (RCTs) compares the safety and efficacy of H-ESD with conventional ESD (C-ESD). METHODS: We searched the PubMed, Embase, Cochrane, Scopus databases for RCTs comparing hybrid and C-ESD for superficial GI neoplasms. Bayesian modeling in Just Another Gibbs Sampler used normal-normal hierarchies for procedure time and logRR for binary outcomes with weakly informative priors. Frequentist analyses were performed using Der-Simonian-Laird τ². Heterogeneity was assessed using I²/τ². RESULTS: H-ESD showed comparable en bloc (RR, 0.97; 95% [CrI], 0.92-1.03; I²=22.8%) and R0 resection rates (RR, 0.97; 95% CrI, 0.90-1.04; I²=0%). Procedure time decreased significantly with H-ESD (MD, -18.05; 95% CrI, -27.77 to -8.33 minutes; I²=66.5%). Adverse events (RR, 1.08; 95% CrI, 0.44-2.63) and perforations (RR, 1.05; 95% CrI, 0.34-3.19) were similar between the two procedures. CONCLUSIONS: H-ESD matches C-ESD in curative resection while reducing the procedure time, offering a safer and more efficient alternative. Larger RCTs are needed to confirm the long-term benefits.
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.