Endoscopic closure of mucosal defects with metallic clips after endoscopic mucosal resection in patients with intramural tumors of the stomach: A retrospective study

Abstract

Background: Representative complications of endoscopic mucosal resection to treat intramural gastric tumors include bleeding and perforation. The purpose of the present study was to clarify whether endoscopic closure of mucosal defects using metallic clips decreases the incidence of delayed bleeding following endoscopic mucosal resection. Patients and Methods: The records of 187 intramural tumors of the stomach in the 181 patients that were treated by endoscopic mucosal resection between 1992 and 2001 were reviewed retrospectively. The patients were classified into two groups. The first group included patients who received endoscopic mucosal resection but were not treated by endoscopic mucosal closure. The second group included patients who were treated with endoscopic mucosal closure using metallic clips after endoscopic mucosal resection. The incidences of delayed bleeding following endoscopic mucosal resection in these two groups were evaluated. Results: Delayed bleeding following endoscopic mucosal resection was observed in 13 of 96 (13.5%) of the lesions of the first group. Delayed bleeding was encountered in only two of 91 (2.2%) lesions of the second group. Conclusions: Endoscopic closure of mucosal defects with metallic clips after endoscopic mucosal resection in gastric lesions was useful in decreasing the incidence of delayed bleeding following endoscopic mucosal resection.Key words: endoscopic closure, endoscopic mucosal resection, endoscopic suture, intramural tumor of the stomach, metallic clip.

Clinical outcomes of endoscopic submucosal dissection for early gastric cancer in patients with chronic kidney disease

“…In addition, the anticoagulation therapy accompanying the patient's hemodialysis may have been cause. Although there has been no enough clinical evidence, endoscopic closure of mucosal defects after ESD or third‐look endoscopy may have a possibility to prevent post‐ESD bleeding.…”

New Endoscopic Technique to Close Large Mucosal Defects After Endoscopic Mucosal Resection in Patients With Gastric Mucosal Tumors

“…However, in all seven cases with large mucosal defects over 30 mm in diameter and incomplete closure, the size of the mucosal defect was reduced sufficiently using the loop‐and‐clips method. Consequently, the benefits of endoscopic mucosal closure (which we previously reported were prevention of delayed bleeding from the artificial ulcer and promotion of rapid wound healing 6 ) were achieved in all seven cases.…”

“…Recently, a number of studies have reported that these clips were useful in the treatment of patients with perforation of the gastrointestinal tract after endoscopic therapeutic procedures 2–5 . We have reported that endoscopic closure of mucosal defects after EMR with metal clips was effective for the prevention of delayed bleeding from artificial ulcers 6 . When we worked with clips alone, however, the limited length of the clip prongs did not allow us to close the large mucosal defect completely, even if we used the so‐called long clips.…”

Prophylactic Clipping to Prevent Delayed Bleeding and Perforation After Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection

“…Besides, pooling of data of 2 included studies may not be accurate given that the 2 studies had 0 postprocedural bleeding event in both groups, resulting in excluded analyses. 17,31 Inomata et al 30 showed that lesions closely associated with delayed bleeding were large mucosal defects that were larger than 21 mm in diameter. In contrast, among the lesions <20 mm in diameter, delayed bleeding following EMR was not detected.…”

“…Two studies reported the location of endoscopic procedure was stomach, postprocedural bleeding was noted in 3 of 117 (2.56%) of prophylactic clipping group, 13 of 122 (10.66%) of nonprophylactic clipping group. 28,30 On pooled analysis, no statistically significant difference was observed between prophylactic clipping versus nonprophylactic clipping for postprocedural bleeding (OR: 0.47, 95% CI: 0.02-8.92; P = 0.617). Medium heterogeneity was noted (I 2 = 64.7%; P = 0.092).…”