S237 Safety and Efficacy of Powered Non-Thermal Endoscopic Resection Device for Removal of Colonic Polyps: A Systematic Review and Meta-Analysis

Introduction: Endoscopic mucosal resection is a procedure commonly utilized for the resection of colonic polyps. However, polyp recurrence over a scarred submucosal base can make resection of residual lesions difficult using conventional techniques. EndoRotor is a non-thermal endoscopic mucosal resection device that has been recently evaluated in the resection of colonic polyps, non-dysplastic Barrett's esophagus, and pancreatic necrosis, but the studies are limited to small sample sizes. Therefore, we performed a systematic review and meta-analysis to evaluate the safety and efficacy of EndoRotor for the resection of colonic polyps. Methods: A systematic review of the literature was performed using Medline, Embase, Web of Science, and the Cochrane library database until June 2022 to identify all studies that evaluated the safety of non-thermal endoscopic resection devices for the removal of colonic polyps. Our primary outcome of interest was the technical success rate, and secondary outcomes included rates of residual lesions and adverse events. All analyses were conducted using comprehensive meta-analysis software. Results: Three studies, including 54 patients who underwent resection of 60 lesions, were included in the analysis. The pooled technical success rate was 93.9% (95% CI: 77.7-98.6%, I2=25.5%). Among patients with a repeat endoscopic evaluation, 20 patients had a residual lesion. The pooled residual lesion rate after the first session was 39.8% (95% CI: 15.3-70.8%, I2=74.5%). There were eight instances of intraoperative bleeding and four cases of post-procedural bleeding. The pooled rate of intraoperative bleeding was 13.2% (95% CI: 6.7-24.3%, I2=0%) and post-procedural bleeding was 8.5% (95% CI: 3.4-19.8%, I2=0%). There was only one event of major bleeding, and no perforations were reported. Conclusion: Our study revealed that EndoRotor is successful in removing scarred colonic polyps, but the residual lesion rate is high and may require multiple sessions for complete removal. Larger prospective studies, especially randomized controlled trials, are needed to evaluate further the efficacy and safety of EndoRotor for removing colonic polyps.