P2432 - Comparative Efficacy of Endoscopic Submucosal Dissection with S-O Clip vs Conventional Endoscopic Submucosal Dissection in Gastric and Colorectal Lesions: A Systematic Review and Meta-Analysis

Aamir Saeed, MD¹, Saira Yousuf, MD¹, Abdul Wasay, MD², Muhammad Abdul Basit, MD³, Hina Akbar, MD⁴, Sam Dabit, ⁵, Amman Yousaf, MD⁶, Nilay Bhatt, MD⁷, Aeman Nisar, MD⁸, Mark Radlinski, MD¹, Nasir Saleem, MD⁹, Umar Hayat, MD¹⁰, Faisal Kamal, MD¹¹
1Vanderbilt University Medical Center, Nashville, TN; 2University of Tennessee, Knoxville, TN; 3United Health Services, Binghamton, NY; 4King Edward Medical University, Chattanooga, TN; 5South Central Regional Medical Center, Laurel, MS; 6Hattiesburg Clinic, Hattiesburg, Hattiesburg, MS; 7HCA Houston Clear Lake, Houston, TX; 8Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; 9Indiana University School of Medicine, Indianapolis, IN; 10Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; 11Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA

Introduction:

Endoscopic submucosal dissection (ESD) allows en-bloc resection of large superficial tumors in gastrointestinal (GI) tract. However, ESD is technically demanding and time-consuming. Traction devices may help overcome these drawbacks. Studies have demonstrated the effectiveness of S-O clips in ESD for colorectal and gastric lesions. We conducted a meta-analysis to evaluate the comparative efficacy of ESD with S-O clip vs. conventional ESD in gastric and colorectal lesions.

Methods:

Several databases were reviewed to identify studies comparing ESD with S-O clip and conventional ESD in patients with gastric and colorectal lesions from inception to November 23, 2024. The databases searched included PubMed, Web of Science Core Collection, Embase, and the Cochrane Database of Systematic Reviews. We only included comparative studies comparing S-O clip assisted ESD with conventional ESD. Our outcomes of interest were en bloc resection, adverse events including delayed bleeding, delayed perforation, and the mean procedure time. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for all dichotomous variables and mean differences with 95% CI for continuous variables. Data was analyzed using random effect model. Heterogeneity was assessed using the I² statistic.

Results:

6 studies comprising 1063 patients (S-O Clip assisted ESD: 380 and C-ESD: 683) met the inclusion criteria. We found no significant difference in rates of en bloc resection, RR (95% CI): 1.04 (0.99, 1.08),p=0.10 (Figure 1A), delayed perforation RR (95% CI): 0.96 (0.26, 3.62), p=0.96 (Figure 1B), and delayed bleeding RR (95% CI): 0.93 (0.42, 2.08),p=0.86 (Figure 2A) between groups. Conventional ESD was associated with longer procedure time as compared to S-O clip assisted ESD in gastric and colorectal lesions, MD (95% CI): 14.59 (3.78, 25.41),p=0.008 (Figure 2B).

Discussion:

Our meta-analysis demonstrates that ESD with S-O clip was associated with shorter procedure time compared to conventional ESD. We found no significant difference in other outcomes between groups.


Figure: Comparison of en bloc resection and delayed perforation between groups


Figure: Comparison of delayed bleeding and procedure time between groups

Disclosures:
Aamir Saeed indicated no relevant financial relationships.
Saira Yousuf indicated no relevant financial relationships.
Abdul Wasay indicated no relevant financial relationships.
Muhammad Abdul Basit indicated no relevant financial relationships.
Hina Akbar indicated no relevant financial relationships.
Sam Dabit indicated no relevant financial relationships.
Amman Yousaf indicated no relevant financial relationships.
Nilay Bhatt indicated no relevant financial relationships.
Aeman Nisar indicated no relevant financial relationships.
Mark Radlinski indicated no relevant financial relationships.
Nasir Saleem indicated no relevant financial relationships.
Umar Hayat indicated no relevant financial relationships.
Faisal Kamal indicated no relevant financial relationships.

Aamir Saeed, MD¹, Saira Yousuf, MD¹, Abdul Wasay, MD², Muhammad Abdul Basit, MD³, Hina Akbar, MD⁴, Sam Dabit, ⁵, Amman Yousaf, MD⁶, Nilay Bhatt, MD⁷, Aeman Nisar, MD⁸, Mark Radlinski, MD¹, Nasir Saleem, MD⁹, Umar Hayat, MD¹⁰, Faisal Kamal, MD¹¹. P2432 - Comparative Efficacy of Endoscopic Submucosal Dissection with S-O Clip vs Conventional Endoscopic Submucosal Dissection in Gastric and Colorectal Lesions: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.