P3041 - Conventional vs Traction Endoscopic Submucosal Dissection for Colorectal Tumors: A Meta-Analysis of Randomized Controlled Trials

Sahib Singh, MD¹, Babu Mohan, MD, MS², Saurabh Chandan, MD³, Neil Sharma, MD⁴, Rakesh Vinayek, MD¹, Sudhir Dutta, MD¹, Sergey V. Kantsevoy, MD⁵, Michelle Le, MD⁶, Douglas G. Adler, MD^7
1Sinai Hospital, Baltimore, MD; ²University of Utah Health School of Medicine, Salt Lake City, UT; ³Creighton University School of Medicine, Omaha, NE; ⁴Parkview Health, Fort Wayne, IN; ⁵Mercy Medical Center, Baltimore, MD; ⁶University of Nebraska Medical Center, Omaha, NE; ⁷Center for Advanced Therapeutic (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO

Introduction: Endoscopic submucosal dissection (ESD) was developed for en bloc removal of pre-malignant and early malignant gastrointestinal (GI) lesions. Compared to the conventional ESD (C-ESD), the traction-assisted method (T-ESD) allows the lesion to be stabilized with more facile dissection. Several studies demonstrated the potential benefit of traction (T-ESD) compared to conventional (C-ESD) technique. We conducted a meta-analysis of all currently reported randomized controlled trials (RCTs) comparing C-ESD to T-ESD for colorectal tumors.

Methods: Embase, Cochrane and MEDLINE databases were searched for RCTs evaluating C-ESD vs T-ESD in patients with colorectal tumors in April 2023. The endpoints of interest were procedure time (minutes), resection speed (mm²/min), R0 and en bloc resection rates, and incidence of adverse events. Standard meta-analysis methods were employed using a random-effects model.

Results: Six RCTs with a total of 566 patients (284 C-ESD vs 282 T-ESD) were included in the final analysis. The mean age of the patients was 67 years and 60% were men. In the C-ESD and T-ESD groups respectively, the average type of lesions were 53.7% and 54.8% protruding or laterally spreading tumor granular type (LST-G), and 46.3% and 45.2% laterally spreading tumor nongranular type (LST-NG); the location of the lesions was 34.1% and 32.4% rectum, and 65.9% and 67.6% rest of the colon; and the average lesion size was 31.5mm and 30.1mm.


As compared with T-ESD technique, the C-ESD group was associated with longer procedure time (SMD 0.91, 95% CI [0.58 to 1.23, p < 0.00001, I² = 65%]) and slower resection speed (SMD -1.03, [-2.01 to -0.06, p = 0.04, I² = 93%]). No significant difference was found in the two groups with respect to R0 resection rate (RR 1.00, [0.94 to 1.06, p = 0.87, I² = 42%]), en bloc resection (RR 0.99, [0.97 to 1.01, p = 0.35, I² = 0%]), incidence of delayed bleeding (RR 0.66, [0.17 to 2.59, p = 0.55, I² = 0%]) and perforation (RR 2.16, [0.75 to 6.27, p = 0.16, I² = 0%]).

Discussion: Based on this meta-analysis of 6 RCTs, the clinical outcomes are similar with T-ESD and C-ESD strategies for colorectal tumors with no significant difference in R0 and en bloc resection. T-ESD was found to be significantly faster. These findings have significant practical implications, and given the multitude of traction tools, may warrant a cost analysis in the future.


Disclosures:


Sahib Singh, MD¹, Babu Mohan, MD, MS², Saurabh Chandan, MD³, Neil Sharma, MD⁴, Rakesh Vinayek, MD¹, Sudhir Dutta, MD¹, Sergey V. Kantsevoy, MD⁵, Michelle Le, MD⁶, Douglas G. Adler, MD⁷. P3041 - Conventional vs Traction Endoscopic Submucosal Dissection for Colorectal Tumors: A Meta-Analysis of Randomized Controlled Trials, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.