Endoscopic Submucosal Dissection with Rubber Bands and Clips Compared to Conventional Endoscopic Submucosal...

The rising number of gastrointestinal (GI) tumors, including esophageal, gastric, and colorectal tumors, makes it essential to develop more effective treatment methods. Endoscopic submucosal dissection (ESD) has become a popular intervention due to its ability to resect the tumor completely and prevent local recurrence. This study evaluates the safety and efficacy of ESD with rubber bands and clips (ESD-RBC) in the treatment of various GI tumors. We systematically searched Embase, Scopus, Web of Science, Medline/PubMed, and Cochrane databases until April 20, 2024. Eligible studies included clinical trials and observational studies focusing on ESD-RBC alone or compared to conventional ESD (C-ESD) in patients with gastrointestinal tumors. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) tool. Statistical analyses were performed using RevMan and R software. ESD-RBC was superior to C-ESD in achieving R0 resection and en bloc resection (OR: 1.99 with 95% CI [1.17 to 3.36], P = 0.01, I² = 0%) and (OR: 5.98 with 95% CI [2.30 to 15.55]; P = 0.0002, I² = 0%), respectively. ESD-RBC enhanced the resection speed compared to C-ESD (MD: 8.48 mm²/min with 95% CI [3.12 to 13.83]; P < 0.00001, I² = 89%) and shortened the procedure duration (MD: - 11.94 min with 95% CI [- 21.98 to - 1.91]; P < 0.00001, I² = 7%). There was no statistically significant difference between both groups in terms of bleeding and delayed bleeding (OR: 1.08 with 95% CI [0.37 to 3.14]; P = 0.89, I² = 0%) and (OR: 0.69 with 95% CI [0.20 to 2.33]; P = 0.55, I² = 0%), respectively. The proportion of R0 resection using ESD-RBC was 90%, with 95% CI [65% to 98%] and I² = 78%. The en bloc resection rate was 96%, with 95% CI [95% to 97%], and I² = 0%. In addition, the raw mean (MRAW) of resection speed was 24.25 mm2/min, with 95% CI [13.48 to 35.02], and I² = 99.4%. ESD-RBC was superior to C-ESD in achieving en bloc resection and R0 resection with a comparable risk of bleeding and delayed bleeding. In addition, ESD-RBC enhanced the resection speed and shortened the procedure duration.