Balloon-assisted ESD shows comparable outcomes to conventional ESD for colorectal polyps

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Surgical laparoscopy, endoscopy & percutaneous techniques Published June 7, 2026 Medically reviewed June 7, 2026 Study authors: Saeed Aamir, Yousuf Saira, Hersh Marc, Duffey Katherine, Hamza Sadiq Muhammad, Razzaq Chaudhry Walee… PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider BA-ESD as an alternative to C-ESD for colorectal polyps, with comparable outcomes and potential time savings in RCTs.

This systematic review and meta-analysis compared balloon-assisted endoscopic submucosal dissection (BA-ESD) with conventional endoscopic submucosal dissection (C-ESD) for colorectal polyps, including 1449 patients. The primary outcomes were en bloc resection and R0 resection. For en bloc resection, the odds ratio was 1.00 (95% CI: 0.51-1.99), indicating no significant difference. For R0 resection, the odds ratio was 1.24 (95% CI: 0.51-3.02), also not significant. Secondary outcomes included procedure time, dissection speed, bleeding, and perforation. Overall, there was no significant difference in procedure time (SMD -0.15, 95% CI: -0.56 to 0.26), but in a subgroup analysis of RCTs, BA-ESD showed a significantly shorter procedure time. Dissection speed showed no significant difference (SMD 0.18, 95% CI: -0.28 to 0.63). Rates of bleeding and perforation were not significantly different between groups. The authors note limitations including conflicting results in previous studies and emphasize that large-scale multicenter RCTs are required to further evaluate these findings. Clinically, BA-ESD and C-ESD appear to have comparable efficacy and safety, with a potential time advantage for BA-ESD in RCT settings.

Study Details

Study typeMeta analysis

Sample sizen = 1,449

EvidenceLevel 1

PublishedJun 2026

PMID41562383

View Original Abstract ↓

BACKGROUND: Balloon-assisted endoscopic submucosal dissection (BA-ESD) can improve endoscopic maneuverability by stabilizing the tip of the scope. Studies have compared BA-ESD with conventional ESD (C-ESD) and reported conflicting results. We conducted a meta-analysis to compare BA-ESD with C-ESD in the management of colorectal polyps. METHODS: Several databases were reviewed from 1985 to December 16, 2024, to identify studies comparing BA-ESD with C-ESD for colorectal polyps. Our outcomes of interest were en bloc resection and R0 resection, procedure time, dissection speed, and adverse events such as perforation and bleeding. We calculated the pooled odds ratio (OR) with 95% CI for categorical variables and the standardized mean difference (SMD) with 95% CI for continuous variables. RESULTS: We included 8 studies with 1449 patients (BA-ESD 420 and C-ESD 1029). We found no significant difference in the rate of en bloc resection, OR (95% CI): 1.00 (0.51-1.99) and R0 resection, OR (95% CI): 1.24 (0.51-3.02) between groups. We found no significant difference in bleeding and perforation between groups. We found no significant difference in procedure time, SMD (95% CI): -0.15 (-0.56 to 0.26) and dissection speed, SMD (95% CI): 0.18 (-0.28 to 0.63) between groups. Subgroup analysis of RCTs showed that the procedure time was significantly shorter in the BA-ESD group. CONCLUSIONS: Our meta-analysis demonstrated comparable outcomes between BA-ESD and C-ESD, although analysis of RCTs demonstrated shorter procedure time with BA-ESD. Large-scale multicenter RCTs are required to further evaluate these findings.