Robotic-assisted endoscopic submucosal dissection for superficial gastrointestinal neoplasms: a bayesian meta-analysis & systematic review.
Superficial gastrointestinal (GI) neoplasms pose a significant global health burden, with endoscopic submucosal dissection (ESD) as the gold standard for curative resection. However, conventional ESD (C-ESD) is technically challenging, with prolonged procedure times and higher complication risks. Robotic-assisted ESD (R-ESD) offers enhanced precision and safety, but evidence is limited. To evaluate the efficacy and safety of R-ESD using a Bayesian single-arm Meta-analysis. Systematic review and Bayesian single-arm meta-analysis. Following PRISMA guidelines and PROSPERO registration (CRD420251273787), we conducted a systematic review and Bayesian single-arm meta-analysis of randomized/nonrandomized comparative and single-arm studies on R-ESD for superficial GI neoplasms. Searches spanned MEDLINE, Embase, Scopus, and others through December 2025. Primary outcomes: en-bloc and R0 resection rates. Secondary outcomes: procedure time, perforation, bleeding. Bayesian random-effects models used non-informative priors; analyses in R with the brms package. Risk of bias was assessed via RoB 2 and NOS; certainty via GRADE. Five studies (183 lesions) were included. Frequentist pooled en-bloc resection rate: 98.2% (95% CI: 0.916-0.996, I2 = 0%); R0: 96.8% (95% CI: 0.759-0.997, I2 = 47.8%). Bayesian medians: en-bloc 93.4% (95% CrI: 0.856-0.971); R0 90.0% (95% CrI: 0.798-0.957). 77.6 min (95% CI: 45.0-110.3, I2 = 99%); perforation: 1.2% (95% CI: 0.002-0.077, I2 = 0%); bleeding: 10.6% (95% CI: 0.019-0.416, I2 = 30.8%). Evidence certainty:low. R-ESD demonstrates promising efficacy and safety, but current evidence is limited to small, mostly non-comparative studies. Larger comparative trials are required before definitive conclusions can be made.
Authors
Das Das, Yathindra Yathindra, Moazzam Moazzam, Paul Paul, Sageer Sageer, Roy Roy, Ganguly Ganguly, Sivakumar Sivakumar, Bakhsh Bakhsh, Patel Patel, Khalid Khalid
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