Endoscopic Loop String-Assisted Clip Suturing Closure of Large Mucosal Defects After Endoscopic Submucosal Dissection in the Sigmoid Colon

Hu, Xiao; Xu, Qinwei; Liu, Weihui

doi:10.14309/ajg.0000000000000505

Cited by 8 publications

(7 citation statements)

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“…Examples of such efforts include loop clip method using an endoloop snare, 78 a clipping method using the "8-ring", 79 "hold-and-drag" closure technique using repositionable clips, 80 and loop string-assisted clip suturing closure technique. 81 In addition, over-the-scope clip also had promising results in post-ESD closure; however, success rate decreased with an increase in the defect size (66% for >30mm vs 100% for defects <20mm). 82 In terms of advances in the endoscopic suturing platform, Kantsevoy et al reported the outcome of 21 patients with iatrogenic colonic perforations (screening colon=2, balloon dilation=1, post EMR/ESD=18) from 2009 to 2014.…”

Section: Post Esd Defect Closurementioning

confidence: 96%

Colorectal Endoscopic Submucosal Dissection: An Update on Best Practice

Keihanian¹,

Othman²

2021

CEG

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Endoscopic submucosal dissection (ESD) is a method of en-bloc resection of neoplastic colorectal lesions which is less invasive compared to surgical resection. Lesion stratification, architecture recognition and estimation of depth of invasion are crucial for patient selection. Expert endoscopists have integrated a variety of classification systems including Paris, lateral spreading tumor (LST), narrow band imaging (NBI), international colorectal endoscopic (NICE) and Japanese NBI expert team (JNET) in their day-to-day practice to enhance lesion detection accuracy. Major societies recommend ESD for LST-non granular (NG), Kudo-VI type, large depressed and protruded colonic lesions with shallow submucosal invasion. Chance of submucosal invasion enhances with increased depth as well as tumor location and size. In comparison to endoscopic mucosal resection (EMR), ESD has a lowerl recurrence rate and higher curative resection rate, making it superior for larger colonic lesions management. Major complications such as bleeding and perforation could be seen in up to 11% and 16% of patients, respectively. In major Western countries, performing ESD is challenging due to limited number of expert providers, lack of insurance coverage, and unique patient characteristics such as higher BMI and higher percentage of previously manipulated lesions.

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Section: Post Esd Defect Closurementioning

confidence: 96%

Colorectal Endoscopic Submucosal Dissection: An Update on Best Practice

Keihanian¹,

Othman²

2021

CEG

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“…P OST-ER MUCOSAL DEFECT closure requires a single clip to grasp the defect edges, and several methods and devices have been proposed to bring the edges closer. 29,31,32,34,37,[74][75][76][77][78][79][80][81][82][83][84][85][86][87][88] Recently, a new device using a reopenable clip with a ring has been devised. 89 In existing reports, the clip and the ring were separated, and the ring could drop into the gastrointestinal tract when the clip was set under endoscopic view.…”

Section: Defect Closure Using Clips and Special Devicesmentioning

confidence: 99%

Suturing techniques with endoscopic clips and special devices after endoscopic resection

Nomura

Sugimoto

Temma

et al. 2022

Digestive Endoscopy

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Endoscopic submucosal dissection is an established method for complete resection of large and early gastrointestinal tumors. However, methods to reduce bleeding, perforation, and other adverse events after endoscopic resection (ER) have not yet been defined. Mucosal defect closure is often performed endoscopically with a clip. Recently, reopenable clips and large‐teeth clips have also been developed. The over‐the‐scope clip enables complete defect closure by withdrawing the endoscope once and attaching the clip. Other methods involve attaching the clip‐line or a ring with an anchor to appose the edges of the mucosal defect, followed by the use of an additional clip for defect closure. Since clips are limited by their grasping force and size, other methods, such as endoloop closure, endoscopic ligation with O‐ring closure, and the reopenable clip over‐the‐line method, have been developed. In recent years, techniques often utilized for full‐thickness ER of submucosal tumors have been widely used in full‐thickness defect closure. Specialized devices and techniques for defect closure have also been developed, including the curved needle and line, stitches, and an endoscopic tack and suture device. These clips and suture devices are applied for defect closure in emergency endoscopy, accidental perforations, and acute and chronic fistulas. Although endoscopic defect closure with clips has a high success rate, endoscopists need to simplify and promote endoscopic closure techniques to prevent adverse events after ER.

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“…Gastrointestinal perforation is a common complication of endoscopic therapy, especially with some novel approaches such as endoscopic submucosal dissection (ESD) 1 , that can lead to serious or even life-threatening outcomes if not handled properly. With the rapid development of endoscopic techniques, various endoscopic suture methods for closing the defect have been reported 2 3 4 . However, most of the closure devices are expensive and require complicated manipulation.…”

Section: Figmentioning

confidence: 99%