Tu1492 HYBRID VERSUS CONVENTIONAL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR TREATMENT OF GASTRIC LESIONS: A COMPARATIVE SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Endoscopic submucosal dissection (ESD) is not widely performed in the United States due technical complexity, risk of adverse events, and procedure duration. Hybrid ESD which is characterized by partial submucosal dissection followed by snare-assisted endoscopic mucosal resection (EMR) may overcome some of these limitations; however. limited data exists to compare this technique to conventional ESD. The primary aim of this study was to perform a structured systematic review and meta-analysis to compare the efficacy and safety of hybrid versus conventional ESD for the treatment of gastric lesions. Individualized search strategies were developed for PubMed, EMBASE, Web of Science, and Cochrane Library databases from inception through October 2019 in accordance with PRISMA and MOOSE guidelines. This was a cumulative meta-analysis performed by calculating pooled proportions with rates estimated using random effects models. Measured outcomes included en-bloc resection rates, margin-negative (R0) resection rates, procedure time, procedure-associated adverse events (including delayed bleeding and perforation), and rates of recurrence. Heterogeneity was assessed with I2 statistics and publication bias by funnel plot using Egger and Begg tests. A total of 4 studies (hybrid ESD=141 patients; traditional ESD=465 patients) were included in this comparative meta-analysis. All studies were retrospective in design with 3 full-text manuscripts and one abstract included. Mean age of patients was 67.01 ±2.00 years with hybrid ESD patients younger than conventional ESD (P<0.001). Histology of lesions included: 2.94% benign lesions, 94.12% low- or high-grade dysplastic lesions, and 2.94% of malignant lesions. Average gastric lesion size was 18.59 ±3.55 mm with larger lesions among patients that underwent traditional ESD (P<0.001). Procedure time was significantly shorter for hybrid ESD (P<0.001). Overall, en-bloc resection rate was significantly decreased for hybrid ESD [OR 0.1064 (95% CI, 0.0184 to 0.6168); P=0.0125) though there was no difference in R0 resection rate [OR 0.5347 (95% CI, 0.5347 to 1.2453); P=0.1467)] – Table. Total adverse events were not different between groups [OR 1.42 (95% CI, 0.2524 to 8.0092); P=0.6899)]. Stratifying by type of adverse events, rate of delayed bleeding and perforation were also similar [OR 2.3236 (95% CI, 0.6158 to 8.7672); P=0.2134) and OR 1.4917 (95% CI, 0.3442 to 4.4658); P=0.5930)]. Only one study documented recurrence rate with no evidence of recurrence regardless of procedure type. Hybrid ESD is a safe and effective technique for removal of gastric lesions. While the procedure is associated with a lower en-bloc resection rate compared to conventional ESD, hybrid ESD results in a similar rate of adverse events with significantly shorter duration of procedure.