Hybrid Endoscopic Resection With Endo-knife and Snare for Colorectal Lesions: A Systematic Review and Meta-analysis

BACKGROUND AND AIMS: Hybrid endoscopic resection with an endo-knife and snare (HYB-ER) has been used to overcome the difficulties of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). This study clarified the role of HYB-ER in colorectal neoplasm treatment. METHODS: We searched PubMed, Web of Science, and the Cochrane Library up to May 2021. Pooled data of patients with non-pedunculated colorectal tumors treated with HYB-ER, EMR, and ESD were analyzed. The outcomes of en bloc resection rate, procedure time, and adverse events (perforation, bleeding, and recurrence) were compared across HYB-ER, EMR, and ESD groups. RESULTS: Twenty-four studies were included in this meta-analysis. The mean tumor sizes were 24.4, 19.9, and 30.3 mm in the HYB-ER, EMR, and ESD groups, respectively. The proportion of en bloc resections following HYB-ER in 1626 colorectal lesions was 82%, with perforation and postprocedural bleeding in 4% and 3% of the cases, respectively. HYB-ER was superior to EMR because of its higher proportion of en bloc resections (57% in EMR) and lower recurrence rates (2% with HYB-ER vs 12% with EMR), but the procedure time for HYB-ER (30.85 minutes) was longer than that for EMR (9.97 minutes) and significantly shorter than for ESD (56.6 minutes). According to meta-regression analysis of tumor size and location, there was no significant difference in the en bloc resection rate between HYB-ER and ESD. CONCLUSION: HYB-ER significantly contributed to improve en bloc resection, with fewer recurrence events than EMR and faster procedure times than ESD, with similar en bloc resection and adverse events. Favorable indications for HYB-ER include colorectal lesions of 20-30 mm in size that are difficult to treat with EMR. Systematic review registration: PROSPERO CRD42020209097.