Scholarlink

Background <p>Endoscopic submucosal dissection (ESD) allows en bloc, organ-sparing removal of large superficial colorectal lesions; however, conventional ESD (C-ESD) is often time intensive, technically challenging, and associated with clinically relevant adverse events. Traction-assisted ESD (TA-ESD) was developed to enhance submucosal visualization and maintain a stable dissection plane. Still, its overall impact on efficiency, effectiveness, and safety, particularly across different levels of operator experience, remains unclear. We therefore compared TA-ESD with C-ESD for superficial colorectal lesions and examined whether endoscopist experience influences outcomes.</p> Methods <p>In line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance, PubMed, Scopus, Web of Science, the Cochrane Library, and ClinicalTrials.gov were searched from inception through 8 November 2025. Randomized controlled trials (RCTs) enrolling patients with superficial colorectal lesions undergoing TA-ESD versus C-ESD and reporting outcomes on an intention-to-treat (ITT) or modified intention-to-treat (mITT) basis were included. Pooled estimates were generated using random-effects models, with prespecified subgroup analyses according to endoscopist experience.</p> Results <p>From 930 screened records, 10 RCTs met the inclusion criteria, totaling 1008 participants (499 TA-ESD; 509 C-ESD). TA-ESD was associated with shorter procedure time than C-ESD (MD = −19.23&#xa0;min; 95% CI −26.7 to −11.8; <i>P</i> &lt; 0.0001), although heterogeneity was substantial and certainty was very low. Resection quality was high and similar between approaches, with no meaningful differences in en bloc or R0 resection rates. In the C-ESD arm, 13% of cases required rescue conversion to traction. TA-ESD increased overall resection speed (MD = 2.06 mm<sup>2</sup>/min; 95% CI 0.59–3.53; <i>P</i> = 0.006). TA-ESD showed a borderline reduction in intraoperative perforation (RR = 0.46; 95% CI 0.215–0.999; <i>P</i> = 0.049), whereas delayed perforation and delayed bleeding were infrequent and did not differ between techniques.</p> Conclusions <p>In colorectal RCTs, TA-ESD was associated with shorter procedure time than C-ESD, consistent with prior meta-analyses. However, certainty for this endpoint was very low, and heterogeneity was substantial. The main demonstrated advantage was procedural efficiency, whereas resection quality and overall safety were broadly comparable. Implementation-related outcomes, including rescue conversion to traction and handover to another operator, were reported in only a limited number of trials and should therefore be considered exploratory and hypothesis-generating rather than definitive. Future multicenter RCTs should standardize workflow-related endpoint definitions and determine which lesions, procedural settings, and operator contexts derive the greatest incremental benefit from dedicated adjunctive traction.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Traction-assisted versus conventional endoscopic submucosal dissection for colorectal lesions: an updated systematic review and meta-analysis of randomized trials

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年6月2日

查看全文
  • L. Fadeli,
  • M. Desouky,
  • L. Alfarone,
  • C. Hassan,
  • R. A. Alqandouz,
  • M. A. Elshwihdi,
  • A. Elghezewi,
  • W. Frandah,
  • A. Sherif,
  • M. Elhadi

摘要

Background

Endoscopic submucosal dissection (ESD) allows en bloc, organ-sparing removal of large superficial colorectal lesions; however, conventional ESD (C-ESD) is often time intensive, technically challenging, and associated with clinically relevant adverse events. Traction-assisted ESD (TA-ESD) was developed to enhance submucosal visualization and maintain a stable dissection plane. Still, its overall impact on efficiency, effectiveness, and safety, particularly across different levels of operator experience, remains unclear. We therefore compared TA-ESD with C-ESD for superficial colorectal lesions and examined whether endoscopist experience influences outcomes.

Methods

In line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance, PubMed, Scopus, Web of Science, the Cochrane Library, and ClinicalTrials.gov were searched from inception through 8 November 2025. Randomized controlled trials (RCTs) enrolling patients with superficial colorectal lesions undergoing TA-ESD versus C-ESD and reporting outcomes on an intention-to-treat (ITT) or modified intention-to-treat (mITT) basis were included. Pooled estimates were generated using random-effects models, with prespecified subgroup analyses according to endoscopist experience.

Results

From 930 screened records, 10 RCTs met the inclusion criteria, totaling 1008 participants (499 TA-ESD; 509 C-ESD). TA-ESD was associated with shorter procedure time than C-ESD (MD = −19.23 min; 95% CI −26.7 to −11.8; P < 0.0001), although heterogeneity was substantial and certainty was very low. Resection quality was high and similar between approaches, with no meaningful differences in en bloc or R0 resection rates. In the C-ESD arm, 13% of cases required rescue conversion to traction. TA-ESD increased overall resection speed (MD = 2.06 mm2/min; 95% CI 0.59–3.53; P = 0.006). TA-ESD showed a borderline reduction in intraoperative perforation (RR = 0.46; 95% CI 0.215–0.999; P = 0.049), whereas delayed perforation and delayed bleeding were infrequent and did not differ between techniques.

Conclusions

In colorectal RCTs, TA-ESD was associated with shorter procedure time than C-ESD, consistent with prior meta-analyses. However, certainty for this endpoint was very low, and heterogeneity was substantial. The main demonstrated advantage was procedural efficiency, whereas resection quality and overall safety were broadly comparable. Implementation-related outcomes, including rescue conversion to traction and handover to another operator, were reported in only a limited number of trials and should therefore be considered exploratory and hypothesis-generating rather than definitive. Future multicenter RCTs should standardize workflow-related endpoint definitions and determine which lesions, procedural settings, and operator contexts derive the greatest incremental benefit from dedicated adjunctive traction.