ArticleBMC gastroenterology2026
A network meta-analysis of strategies for endoscopic submucosal dissection procedures from the perspectives of efficacy, duration and safety.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundEndoscopic submucosal dissection (ESD) is a well-accepted endoscopic resection modality for early-stage gastrointestinal tumors. Over the past decades, progressive refinements in instruments, traction methods, and closure techniques have enhanced the safety and efficacy of ESD, and ESD further evolves into conventional ESD (C-ESD), traction-assisted ESD (T-ESD), and underwater ESD (U-ESD). The three modalities have their distinct benefits and are complementary to each other in clinical practice. At the same time, they compete with one another, presenting a challenge to operators with respect to which to select in specific scenarios.
objectiveTo conduct a network meta-analysis to make comparisons of the three approaches of ESD, with a focus on key endpoints including their operative duration, resection rate, R0 resection rate, and adverse event incidence.
methodsA computerized search was conducted across PubMed, Embase, Web of Science, and Cochrane Library databases. The literature was evaluated using the PRISMA 2020 framework. The netmeta package was used for pairwise and network meta-analysis. Continuous outcomes were pooled as mean differences, and dichotomous outcomes were pooled as risk ratios. When continuous data were reported as medians with interquartile ranges or ranges, values were converted to approximate means and standard deviations before pooling.
resultsNine English-language randomized controlled trials involving 919 participants were included. The pooled absolute estimates showed that T-ESD and U-ESD had higher procedure speeds than C-ESD (19.61 and 18.99 vs. 15.20 mm
conclusionCompared with C-ESD, U-ESD and T-ESD showed favorable trends for different procedural endpoints, but the certainty of superiority varied across outcomes. T-ESD ranked highest for procedure speed, median procedure time, en bloc resection, and R0 resection, whereas U-ESD ranked highest for adverse events. Because several dichotomous outcomes had confidence intervals crossing the null value, SUCRA-based rankings should be interpreted as comparative probability rankings rather than definitive proof of clinical superiority.
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