Hasan Fariha, Ali Aizaz, Banatwala Umm E Salma Shabbar, Zaman Bushra, Ali Hassam, Karna Rahul, Butt Muhammad Ali, Dahiya Dushyant Singh, Gangwani Manesh Kumar, Chandan Saurabh, Hayat Umar, Bharadwaj Hareesha Rishab, Khan Hafiz Muzaffar Akbar
Department of Internal Medicine, Cooper University Hospital, Camden, NJ, USA.
Department of Internal Medicine, Khyber Medical College, Peshawar, Pakistan.
Dig Dis Sci. 2025 Jul 8. doi: 10.1007/s10620-025-09204-7.
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.
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.
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 mm/min, P < 0.001). No significant differences were observed in intraoperative perforation or post-ESD bleeding rates.
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.
内镜黏膜下剥离术（ESD）是一种用于治疗早期胃肠道肿瘤的微创手术。虽然有效，但由于黏膜下视野有限、手术时间延长以及穿孔和出血等不良事件风险增加，ESD在技术上可能具有挑战性。S-O夹是一种旨在增强黏膜下暴露的牵引装置，可能有助于克服这些限制并改善手术效果。
我们对比较有或无S-O夹的ESD治疗胃肠道肿瘤患者的研究进行了系统评价和荟萃分析。主要结局包括整块切除率、完全切除率和手术时间。次要结局为剥离速度和不良事件，包括术中穿孔和ESD术后出血。计算合并相对风险（RR）和平均差（MD）。根据病变部位进行亚组分析。
纳入了17项涉及1449例患者的研究。使用S-O夹显著缩短了手术时间（MD：-19.63分钟，95%CI：-28.02至-11.23，P<0.001），并提高了整块切除率（RR：1.05，95%CI：1.01-1.09，P=0.01）。两组间完全切除率相似（RR：1.03，P=0.23）。使用S-O夹时剥离速度显著更高（MD：10.18毫米/分钟，P<着0.001）。术中穿孔率或ESD术后出血率未观察到显著差异。
S-O夹是ESD中一种有用的辅助工具，可提高效率和整块切除率，而不增加不良事件。其使用可能改善手术效果，尤其是在胃和结直肠ESD中。
