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Planned Hybrid Endoscopic Submucosal Dissection as Alternative for Colorectal Neoplasms: A Propensity Score-Matched Study

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Abstract

Background and Aims

Hybrid endoscopic submucosal dissection (H-ESD), a modified ESD with a snare, has become increasingly utilized to overcome the limitations of conventional ESD (C-ESD). This study aimed to compare the efficacy and safety of Planned H-ESD and C-ESD for colorectal lesions.

Methods

Propensity score matching was performed to control for confounding variables in this retrospective study. Outcomes included en bloc resection and complete resection (R0) rates, procedure time, adverse event rates, and local recurrence rate.

Results

1286 lesions were enrolled in the study. After matching, 263 lesions were assigned to each group. The Planned H-ESD group has lower en bloc rate but similar R0 resection rate compared to the C-ESD group (90.9% vs 98.1%, P = 0.001; 77.2% vs 77.9%, P = 0.917). The median procedure time was shorter in the Planned H-ESD group (27.0 min vs 35.0 min, P = 0.001). There were no significant differences in adverse events rates or local recurrence rate. Subgroup analysis based on lesion size revealed that a significantly lower en bloc resection rate in the Planned H-ESD group compared to the C-ESD group for lesions ≥ 40 mm (71.0% vs 94.3%, P = 0.027), but there was no significant difference for lesions < 40 mm.

Conclusion

The Planned H-ESD has a lower en bloc resection rate but a similar R0 resection rate, adverse event rates, local recurrence rate, and shorter procedure duration. Compared to C-ESD, Planned H-ESD presents advantages for managing colorectal neoplasms below 40 mm.

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Acknowledgments

Financial support and technical assistance were not received for this study.

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Authors and Affiliations

  1. Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, China

    Yu-xin Zhang, Xun Liu, Fang Gu & Shi-gang Ding

  2. Beijing Key Laboratory for Helicobacter Pylori Infection and Upper Gastrointestinal Diseases, Beijing, 100191, China

    Yu-xin Zhang, Xun Liu, Fang Gu & Shi-gang Ding

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  2. Xun Liu
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Contributions

SGD and YXZ designed the study; YXZ and XL collected and/or analyzed the data; YXZ wrote the initial draft of the manuscript; FG assisted in revision of the manuscript; SGD critically reviewed the manuscript and approved the final version of the manuscript. All authors approved the manuscript and agree on submission of the manuscript for publication.

Corresponding author

Correspondence to Shi-gang Ding.

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The authors declare no conflicts of interest.

Ethical approval

This study was approved by the Medical Ethics Committee of Peking University Third Hospital (M2022769).

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Zhang, Yx., Liu, X., Gu, F. et al. Planned Hybrid Endoscopic Submucosal Dissection as Alternative for Colorectal Neoplasms: A Propensity Score-Matched Study. Dig Dis Sci 69, 949–960 (2024). https://doi.org/10.1007/s10620-023-08195-7

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  • DOI: https://doi.org/10.1007/s10620-023-08195-7

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