S2322 Safety and Efficacy of Magnetic Anchor-Guided Endoscopic Submucosal Dissection for Gastrointestinal Lesions and Comparison With Conventional ESD: A Systematic Review and Meta-Analysis

Introduction: Conventional endoscopic submucosal dissection (C-ESD) has been widely used for treatment for early gastric cancer and large colorectal lesions. However, poor visualization of the operative field increases both the procedure time and the risk of complications, especially for large and difficult lesions. The feasibility of magnetic anchor-guided endoscopic submucosal dissection (MAG-ESD) has not been evaluated yet. We conducted a meta-analysis to evaluate comparative outcomes of MAG-ESD and C-ESD in GI lesions, especially large colorectal lesions. Methods: Several databases were reviewed from inception to April 11, 2025, to identify studies comparing the outcomes of MAG-ESD and C-ESD in GI lesions. Our outcomes of interest were en bloc resection, R0 resection, perforation, overall bleeding, procedure time and dissection speed. We calculated risk ratios (RRs) with 95% CI for categorical variables and mean differences with 95% CI for continuous variables. Data was analyzed using the random effect model. Heterogeneity was assessed using I 2 statistics. Results: We included 7 studies (3 comparative and 4 single arm) with 480 patients (MAG-ESD 196, C-ESD 480) in our analysis. Four studies reported the data on large colorectal lesions and 3 studies reported on gastric lesions. The mean age of the patients was 64.4 (4.7) years. Comparative analysis of MAG-ESD and C-ESD showed that MAG-ESD was associated with shorter procedure time (minutes), MD (95% CI): -11.7 (-14.62, -7.92) P < 0.00001, I2 0% and higher dissection speed (mm2/min), MD (95% CI): 7.30 (5.56, 9.05) P < 0.00001, I2 0% as compared to C-ESD. There was no significant difference of en bloc resection (P = 0.55), R0 resection (P = 0.42), and bleeding rates (P = 0.53) between the groups. Pooled rates (95% CI) of en bloc resection of MAG-ESD were 98.1%(94.7%, 99.3%), P = 0.99, I2 0%, complete resection, 98.1% (94.2%, 99.4%), P = 0.97, I2 0%, and overall bleeding, 2.8% (1.1%, 6.9%), P = 0.9, I2 0%. One case of perforation was reported in C-ESD. Conclusion: Our meta-analysis demonstrates that MAG-ESD was associated with shorter procedure time and higher dissection speed as compared to conventional ESD. MAG-ESD can be used for larger sizes and lesions in difficult locations. Future multicenter studies are needed to validate these findings further.