Supplementary Material for: Compared the effectiveness and safety of different methods of colorectal endoscopic submucosal dissection: a systematic review and network meta-analysis

Background: Traditional endoscopic submucosal dissection (ESD) has developed different methods, such as pocket method(P-ESD), traction-assisted method(T-ESD) and Hybrid method(H-ESD). In this meta-analysis, the benefits and drawbacks of different ESD methods were discussed and ranked. Study design: Studies comparing different methods of colorectal ESD were searched by PubMed, Embase, and Cochrane Library databases. The study was conducted for five endpoints: en bloc resection rate, R0 resection rate, operation time, dissection speed, and adverse events rate. Pairwise and network meta-analyses were performed through Rev Man 5.4 and Stata 16.0. The quality of all included studies was assessed using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. Results: Twenty-six studies met the inclusion criteria, including 7 RCTs and 19 non-RCTs, with a total of 3002 patients. The pooled analysis showed that the en bloc resection rate of H-ESD was significantly lower than C-ESD, P-ESD and T-ESD [RR=0.28, 95%CI (0.12, 0.65); RR = 0.11, 95% CI (0.03, 0.44); RR = 8.28, 95% CI (2.50, 27.42)]. Compared with C-ESD, the operation time of H-ESD and T-ESD was significantly shorter [MD=-21.83, 95%CI (-34.76, -8.90); MD=-23.8, 95%CI (-32.55, -15.06)]. Meanwhile, the operation time of T-ESD was also significantly shorter than P-ESD [MD=-18.74, 95%CI (-31.93, -5.54)]. The dissection speed of T-ESD was significantly faster than C-ESD [MD=6.26, 95%CI (2.29, 10.23)]. Conclusion: P-ESD and T-ESD are probably the two best methods of colorectal ESD at present. The advantages of P-ESD are high en bloc resection rate and low incidence of adverse events. The advantages of T-ESD are rapid dissection and short operation time.背景：传统内镜黏膜下剥离术（endoscopic submucosal dissection, ESD）已发展出多种术式，如荷包法（pocket method, P-ESD）、牵引辅助法（traction-assisted method, T-ESD）及混合法（Hybrid method, H-ESD）。本项Meta分析探讨并排序了不同ESD术式的优劣。 研究设计：本研究通过PubMed、Embase及Cochrane Library数据库检索对比结直肠ESD不同术式的相关研究，共设置5项结局指标：整块切除率、R0切除率、手术时间、剥离速度及不良事件发生率。采用Rev Man 5.4及Stata 16.0软件开展成对比较与网络Meta分析，使用Cochrane偏倚风险工具及纽卡斯尔-渥太华量表对纳入研究的质量进行评估。 结果：最终有26项研究符合纳入标准，其中包含7项随机对照试验（randomized controlled trial, RCT）与19项非随机对照试验，共计纳入3002例患者。合并分析结果显示，混合法ESD（H-ESD）的整块切除率显著低于传统ESD（conventional endoscopic submucosal dissection, C-ESD）、荷包法ESD（P-ESD）及牵引辅助法ESD（T-ESD）[RR=0.28, 95%CI(0.12, 0.65)；RR=0.11, 95%CI(0.03, 0.44)；RR=8.28, 95%CI(2.50, 27.42)]。与传统ESD（C-ESD）相比，混合法ESD（H-ESD）及牵引辅助法ESD（T-ESD）的手术时间显著更短[MD=-21.83, 95%CI(-34.76, -8.90)；MD=-23.8, 95%CI(-32.55, -15.06)]。同时，牵引辅助法ESD（T-ESD）的手术时间也显著短于荷包法ESD（P-ESD）[MD=-18.74, 95%CI(-31.93, -5.54)]。牵引辅助法ESD（T-ESD）的剥离速度显著快于传统ESD（C-ESD）[MD=6.26, 95%CI(2.29, 10.23)]。 结论：目前结直肠ESD的最优术式或为荷包法ESD（P-ESD）与牵引辅助法ESD（T-ESD）。荷包法ESD的优势在于整块切除率高、不良事件发生率低；牵引辅助法ESD的优势在于剥离速度快、手术时间短。