Hybrid versus conventional endoscopic submucosal dissection for treatment of gastric lesions: a comparative systematic review and meta-analysis

Background and Aims: Hybrid endoscopic submucosal dissection (ESD) may overcome the complexity of conventional ESD associated with gastric lesions. The aim of this study was to perform a systematic review and meta-analysis to compare the efficacy and safety of hybrid versus conventional ESD for the treatment of gastric lesions. Methods: Individualized search strategies were developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. Pooled proportions were calculated with rates estimated using random-effects models. Measured outcomes included en-bloc resection, procedure-associated adverse events, and procedure duration. Heterogeneity was assessed with the I² statistic and publication bias using funnel plots and Egger regression testing. Results: Of 5 included comparator studies (hybrid ESD, 184 patients; conventional ESD, 289 patients), 1 was a randomized trial and 4 were retrospective observational studies. Mean patient age was 68.89 ± 4.75 years, and the average lesion size was 17.81 ± 5.58 mm. Hybrid ESD patients were older (P < .001) with smaller lesions (15.75 ± 4.72 mm vs 19.12 ± 5.69 mm; P < .001). Overall, the en-bloc resection rate was significantly decreased for hybrid ESD (odds ratio [OR], .11; 95% confidence interval [CI], .02-.62; P = .010). Total adverse events were not different between groups (OR, 1.56; 95% CI, .44-5.53; P = .490). Rates of delayed bleeding (OR, 1.47; 95% CI, .34-6.40; P = .610) and perforation (OR, 2.41; 95% CI, .65-9.12; P = .194) were also not significantly different. Procedure time was significantly shorter for hybrid ESD (mean difference, 15.13 minutes; 95% CI, 4.05-26.21; P = .007). Conclusions: Although hybrid ESD for gastric lesions was associated with significantly shorter procedure times compared with conventional ESD, hybrid ESD was associated with lower rates of en-bloc resection and similar adverse events.