Over the scope clips after endoscopic removal of duodenal tumors: a systematic review and meta-analysis

Aims Over-the-scope clips (OTS-clips) are used after endoscopic resections to treat mucosal defects, postoperative anastomotic leakages, and gastrointestinal perforations. Duodenal endoscopic submucosal dissection (ESD) is associated with a high complication rate and adverse events with conventional clip closure. Therefore, we aim to assess the safety and efficacy of OTS-clips compared to conventional clips in patients undergoing ESD.

Methods Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched four electronic databases (PubMed, Scopus, Cochrane Library, and Web of Science) to identify eligible studies reported up to November 2024. Using R statistical software (version 2024.04.2 Build 764), we reported outcomes as pooled mean difference (MD), pooled risk ratio (RR), and confidence intervals (CIs).

Results Twelve studies, with a total population of 700 participants were included. Our analysis of technical success, considering the OTS-clips group showed a pooled proportion of 0.94, 95% CI [0.87, 0.97], and a nonsignificant heterogeneity (I2=0%, P = 0.70). Considering the OTS-clips group, en bloc resection and full-thickness resection proportion were 0.98, 95% CI [0.93, 1.00] and 0.91, 95% CI [0.71, 0.98] respectively. Regarding the adverse events, there were no significant differences between the two groups regarding intra-operative perforation, post-operative bleeding, and post-operative perforation. Considering the OTS-clips group versus the conventional clips group, R0 resection significantly favored the OTS-clips group 1.35, 95% CI [1.06, 1.73] with nonsignificant heterogeneity (I2=0%, P = 0.50). Procedure time and hospital Stay showed no difference between the groups.

Conclusions These results emphasis the potential beneficial role of OTS-clips and highlight its clinical utility as an adjunctive therapy to ESD in the management of duodenal tumors. Large-scale studies are recommended to delineate the significance of possible important outcomes such as mortality rate and adverse events.

Publication History

Article published online:
27 March 2025