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Efficacy of scissor-type knife for endoscopic submucosal dissection: a systematic review and meta-analysis

BACKGROUND: Endoscopic submucosal dissection (ESD) is an effective resection technique for early cancers and large gastrointestinal luminal lesions. However, ESD is technically challenging, with the potential for severe adverse events. Scissor-type ESD (ST-ESD) knives with an inner cutting edge and...

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Autores principales: Gopakumar, Harishankar, Vohra, Ishaan, Sharma, Neil R., Puli, Srinivas R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hellenic Society of Gastroenterology 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10662071/
https://www.ncbi.nlm.nih.gov/pubmed/38023980
http://dx.doi.org/10.20524/aog.2023.0838
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author Gopakumar, Harishankar
Vohra, Ishaan
Sharma, Neil R.
Puli, Srinivas R.
author_facet Gopakumar, Harishankar
Vohra, Ishaan
Sharma, Neil R.
Puli, Srinivas R.
author_sort Gopakumar, Harishankar
collection PubMed
description BACKGROUND: Endoscopic submucosal dissection (ESD) is an effective resection technique for early cancers and large gastrointestinal luminal lesions. However, ESD is technically challenging, with the potential for severe adverse events. Scissor-type ESD (ST-ESD) knives with an inner cutting edge and an electrically insulated external coating could mitigate some of these risks. This study aimed to evaluate the performance of ST electrosurgical knives when used for ESDs. METHODS: Electronic databases were queried for studies from January 2005 through December 2022 evaluating the performance of ST-ESD knives. Fixed- and random-effects models were used to calculate pooled proportions. Heterogeneity was assessed using the I(2) test and by constructing funnel plots, while bias was calculated using Egger and Harbord bias indicators. RESULTS: Final analysis included data from 17 studies comprising 1652 ESD procedures. The pooled en bloc resection rate and R0 resection rate were 97.94% (95% confidence interval [CI] 97.20-98.57) and 94.32% (95%CI 93.11-95.43), respectively. The main adverse events were perforation and delayed post-procedural bleeding, with pooled rates of 1.07% (95%CI 0.63-1.62) and 1.86% (95%CI 1.26-2.56), respectively. There was no heterogeneity, as indicated by an I(2) score of 0% (95%CI 0-44.50%). The mean procedure time was 67.45 min (95%CI 58.01-76.89). CONCLUSIONS: Our analysis shows that ST-ESD knives deliver consistently good performance across various locations in the gastrointestinal lumen and lesion sizes, with a good safety profile. This could be particularly appealing to newer adopters of ESD.
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spelling pubmed-106620712023-11-01 Efficacy of scissor-type knife for endoscopic submucosal dissection: a systematic review and meta-analysis Gopakumar, Harishankar Vohra, Ishaan Sharma, Neil R. Puli, Srinivas R. Ann Gastroenterol Original Article BACKGROUND: Endoscopic submucosal dissection (ESD) is an effective resection technique for early cancers and large gastrointestinal luminal lesions. However, ESD is technically challenging, with the potential for severe adverse events. Scissor-type ESD (ST-ESD) knives with an inner cutting edge and an electrically insulated external coating could mitigate some of these risks. This study aimed to evaluate the performance of ST electrosurgical knives when used for ESDs. METHODS: Electronic databases were queried for studies from January 2005 through December 2022 evaluating the performance of ST-ESD knives. Fixed- and random-effects models were used to calculate pooled proportions. Heterogeneity was assessed using the I(2) test and by constructing funnel plots, while bias was calculated using Egger and Harbord bias indicators. RESULTS: Final analysis included data from 17 studies comprising 1652 ESD procedures. The pooled en bloc resection rate and R0 resection rate were 97.94% (95% confidence interval [CI] 97.20-98.57) and 94.32% (95%CI 93.11-95.43), respectively. The main adverse events were perforation and delayed post-procedural bleeding, with pooled rates of 1.07% (95%CI 0.63-1.62) and 1.86% (95%CI 1.26-2.56), respectively. There was no heterogeneity, as indicated by an I(2) score of 0% (95%CI 0-44.50%). The mean procedure time was 67.45 min (95%CI 58.01-76.89). CONCLUSIONS: Our analysis shows that ST-ESD knives deliver consistently good performance across various locations in the gastrointestinal lumen and lesion sizes, with a good safety profile. This could be particularly appealing to newer adopters of ESD. Hellenic Society of Gastroenterology 2023 2023-10-30 /pmc/articles/PMC10662071/ /pubmed/38023980 http://dx.doi.org/10.20524/aog.2023.0838 Text en Copyright: © Hellenic Society of Gastroenterology https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Gopakumar, Harishankar
Vohra, Ishaan
Sharma, Neil R.
Puli, Srinivas R.
Efficacy of scissor-type knife for endoscopic submucosal dissection: a systematic review and meta-analysis
title Efficacy of scissor-type knife for endoscopic submucosal dissection: a systematic review and meta-analysis
title_full Efficacy of scissor-type knife for endoscopic submucosal dissection: a systematic review and meta-analysis
title_fullStr Efficacy of scissor-type knife for endoscopic submucosal dissection: a systematic review and meta-analysis
title_full_unstemmed Efficacy of scissor-type knife for endoscopic submucosal dissection: a systematic review and meta-analysis
title_short Efficacy of scissor-type knife for endoscopic submucosal dissection: a systematic review and meta-analysis
title_sort efficacy of scissor-type knife for endoscopic submucosal dissection: a systematic review and meta-analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10662071/
https://www.ncbi.nlm.nih.gov/pubmed/38023980
http://dx.doi.org/10.20524/aog.2023.0838
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