Evidence map›Paper›PMID 40629231›Full record

SynthesisDigestive diseases and sciences2025

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

Fariha Hasan, Aizaz Ali, Umm E Salma Shabbar Banatwala, Bushra Zaman, Hassam Ali, Rahul Karna, Muhammad Ali Butt, Dushyant Singh Dahiya, Manesh Kumar Gangwani, Saurabh Chandan and 3 more

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Digestive diseases and sciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Fariha HasanDepartment of Internal Medicine, Cooper University Hospital, Camden, NJ, USA.
Aizaz AliDepartment of Internal Medicine, Khyber Medical College, Peshawar, Pakistan.
Umm E Salma Shabbar BanatwalaDepartment of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Bushra ZamanDepartment of Internal Medicine, People's University of Medical and Health Sciences for Women, Nawabshah, Pakistan.
Hassam AliDivision of Gastroenterology, Hepatology, and Nutrition, East Carolina University Health Medical Center, Greenville, NC, USA. alih20@ecu.edu.
Rahul KarnaDivision of Gastroenterology, Hepatology & Nutrition, University of Minnesota Medical Center, Minneapolis, MN, USA.
Muhammad Ali ButtDivision of Gastroenterology, Hepatology & Nutrition, University of Minnesota Medical Center, Minneapolis, MN, USA.
Dushyant Singh DahiyaDivision of Gastroenterology, Hepatology, and Motility, School of Medicine, The University of Kansas Medical School, Kansas City, KS, USA.
Manesh Kumar GangwaniDepartment of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Saurabh ChandanCenter for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA.
Umar HayatDepartment of Internal Medicine, Geisinger Health System, Pennsylvania, USA.
Hareesha Rishab BharadwajFaculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Hafiz Muzaffar Akbar KhanCenter for Interventional Endoscopy, AdventHealth Tampa, Florida, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEndoscopic 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.

methodsWe 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.

resultsSeventeen 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

conclusionsThe 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.

Indexed as

Endoscopic Mucosal ResectionGastrointestinal NeoplasmsSurgical InstrumentsHumansOperative TimeTreatment OutcomeEndoscopic submucosal dissectionGastrointestinal neoplasmsMinimally invasive surgical proceduresSurgical clipsTreatment outcome

Identifiers

PMID40629231
PMCPMC12627136

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.