Optimizing Endoscopic Submucosal Dissection: A Meta-Analysis of the S-O Clip's Impact on Procedural Outcomes and Lesion-Specific Applications

Abstract

Background: Endoscopic submucosal dissection (ESD) is a minimally invasive procedure used to treat early-stage gastrointestinal neoplasms. While effective, ESD can be technically challenging due to limited submucosal visibility, prolonged procedure time, and increased risk of adverse events such as perforation and bleeding. The S-O clip, a traction device designed to enhance submucosal exposure, may help overcome these limitations and improve procedural outcomes.

Methods: We conducted a systematic review and meta-analysis of studies comparing ESD with and without the S-O clip in patients with gastrointestinal neoplasms. Primary outcomes included en-bloc resection rate, complete resection rate, and procedure time. Secondary outcomes were dissection speed and adverse events, including intraoperative perforation and post-ESD bleeding. Pooled relative risks (RR) and mean differences (MD) were calculated. Subgroup analyses were performed based on lesion location.

Results: Seventeen studies involving 1,449 patients were included. Use of the S-O clip significantly reduced procedure time (MD: - 19.63 min, 95% CI: - 28.02 to - 11.23, P < 0.001) and increased en-bloc resection rate (RR: 1.05, 95% CI: 1.01-1.09, P = 0.01). Complete resection rates were similar between groups (RR: 1.03, P = 0.23). Dissection speed was significantly higher with the S-O clip (MD: 10.18 mm²/min, P < 0.001). No significant differences were observed in intraoperative perforation or post-ESD bleeding rates.

Conclusions: The S-O clip is a useful adjunct in ESD, improving efficiency and en-bloc resection without increasing adverse events. Its use may enhance outcomes, particularly in gastric and colorectal ESD.

Keywords: Endoscopic submucosal dissection; Gastrointestinal neoplasms; Minimally invasive surgical procedures; Surgical clips; Treatment outcome.