S409 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

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 (C-ESD). Our outcomes of interest were en block 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: Six studies comprising 1,063 patients (S-O Clip assisted ESD: 380 and C-ESD: 683) met the inclusion criteria. We found no significant difference in rates of en block resection, RR (95% CI): 1.04 (0.99, 1.08), P = 0.10, delayed perforation RR (95% CI): 0.96 (0.26, 3.62), P = 0.96, and delayed bleeding RR (95% CI): 0.93 (0.42, 2.08), P = 0.86 between groups. C-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. Conclusion: 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.