Traction assisted endoscopic submucosal dissection: a systematic review and meta-analysis

Aims The rising number of gastrointestinal tumors including esophageal, gastric, and colorectal cancers makes it essential to develop more effective methods of treatment. Endoscopic submucosal dissection (ESD) has become a preferred intervention due to its high ability to excise the tumor radically and prevent local recurrence. This study evaluates the safety and efficacy of ESD with rubber bands and clips (ESD-RBC) in the treatment of different GI cancers.

Methods We systematically searched Embase, Scopus, Web of Science, Medline/PubMed, and Cochrane databases up to April 20, 2024. Eligible studies included observational studies focusing on ESD-RBC alone or compared to conventional endoscopic submucosal dissection (C-ESD) in patients with gastrointestinal tumors. The risk of bias was assessed using the New Castle Ottawa Scale (NOS) tool. Statistical analyses were performed using RevMan and R software.

Results ESD-RBC was superior to C-ESD in achieving en-bloc resection and R0 resection; (OR: 6.10 with 95% CI [2.39 to 15.56]; P=0.0002), and (OR: 1.95 with 95% CI [1.14 to 3.33], P=0.01), respectively. There was no statistically significant difference between both groups in terms of bleeding and delayed bleeding; (OR: 0.70 with 95% CI [0.20 to 2.49]; P=0.59) and (OR: 0.72 with 95% CI [0.17 to 3.13]; P=0.66), respectively. The proportion of R0 resection using ESD-RBC was 90% with 95% CI [81% to 95%], and en-bloc resection was 96% with 95% CI [94% to 97%]. In addition, the raw mean (MRAW) of resection speed was 27.4 with 95% CI [17.66 to 37.24].

Conclusions Both ESD-RBC and C-ESD approaches yielded comparable outcomes in terms of bleeding and delayed bleeding, but ESD-RBC was superior to C-ESD in achieving higher rates of R0 resection and en-bloc resection. Also, ESD-RBC enhanced the resection speed and lowered the procedure duration.

Publication History

Article published online:
27 March 2025