Prophylactic clip closure may reduce the risk of delayed bleeding after colorectal endoscopic submucosal dissection

Ogiyama, Hideharu; Tsutsui, Shusaku; Murayama, Yoko; Maeda, Shingo; Satake, Shin; Nasu, Ayaka; Umeda, Daisuke; Miura, Yoshio; Tominaga, Kouhei; Horiki, Masashi; Sanomura, Tamana; Imanaka, Kazuho

doi:10.1055/a-0581-8886

Cited by 33 publications

(30 citation statements)

References 30 publications

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“…Further larger controlled studies, however, are needed to validate these findings. with standard hemostatic clips or an over-the-scope-clip which remains challenging in large defects [3][4][5]. More advanced closure techniques include using clips to anchor an endoloop in a purse-string manner or hand-suturing through an overtube [6,7].…”

Section: Resultsmentioning

confidence: 99%

“…In patients requiring anticoagulation or antiplatelet agents, minimizing the risk of bleeding is even more critical, emphasizing the importance of prophylactic methods. Prior studies examining placement of hemostatic clips have shown rates of bleeding as low as 0 % in the colon, but are challenging to perform in larger defects due to the inability to adequately approximate the defect edges [3,5,14]. Furthermore, numerous clips may be required which can add significant time and cost.…”

Section: Discussionmentioning

confidence: 99%

“…To potentially improve healing and prevent related AEs, various methods have been described to close these post-ESD defects. The most common method entails prophylactic clipping with standard hemostatic clips or an over-the-scope-clip which remains challenging in large defects 3 4 5 . More advanced closure techniques include using clips to anchor an endoloop in a purse-string manner or hand-suturing through an overtube 6 7 .…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of endoscopic suturing to prevent adverse events and hospitalization after endoscopic submucosal dissection

et al. 2020

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Background and study aim Endoscopic submucosal dissection (ESD) enables en bloc removal of gastrointestinal epithelial lesions but can leave a large mucosal defect, which can lead to inpatient observation and delayed bleeding or perforation. The aim of this study was to examine the safety and effectiveness of endoscopic suturing in closing ESD defects to prevent adverse events. Patients and methods In this single-center prospective cohort study, endoscopic suturing was performed to close ESD defects in the stomach or rectum. Suturing was performed in the antegrade position starting from the edge most distal to the endoscope insertion site, moving from right to left, left to right manner before ending at the edge most proximal to the endoscope insertion site. Results In total, 31 patients (mean age 65.6, 71 % male) received endoscopic suturing after gastric (58.1 %) or rectal (41.9 %) ESD. Mean lesion size was 27.4 ± 16.2 mm and mean suturing time was 13.4 ± 5.9 min. Complete closure was achieved in all patients. Same-day discharge occurred in 58.1 % of patients; the remainder were hospitalized with mean length of stay of 1 ± 0.6 day. There were no instances of delayed bleeding or delayed perforation (0 %, 95 % CI: 0–11.5 %). No recurrences were found on surveillance endoscopy. Conclusions Based on this small prospective study, endoscopic suturing of post-ESD defects in the stomach and rectum appears to be feasible, safe, and potentially effective in preventing bleeding or perforation. Further larger controlled studies, however, are needed to validate these findings.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility of endoscopic suturing to prevent adverse events and hospitalization after endoscopic submucosal dissection

et al. 2020

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“…However, another study for large colorectal lesions (≥2 cm) has shown that prophylactic clipping decreased the risk of delayed post-polypectomy bleeding [19]. Recent studies have shown that prophylactic clip closure of mucosal defects reduced the risk of delayed bleeding after colorectal ESD [20,21].…”

Section: Bleedingmentioning

confidence: 99%

Management of Complications of Colorectal Submucosal Dissection

Kim

Chang

2019

Clin Endosc

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Endoscopic submucosal dissection (ESD) is a useful procedure for the treatment of superficial gastrointestinal neoplasm. Compared with endoscopic mucosal resection (EMR), ESD has several benefits, which include resectability of various difficult lesion, accurate histologic assessment of specimen, and lower recurrence rate. However, the risk of procedure-related complications is higher with ESD than with EMR. Moreover, because the colon has a thin wall and limited endoscopic maneuverability, ESD is considered a more challenging and risky procedure when performed in the colon than in the stomach. ESD-related complications are more likely to occur. The significant complications associated with ESD are bleeding, perforation, coagulation syndrome and stenosis, most of which can be treated and prevented by endoscopic intervention and preparation. Therefore, it is important to know how to occur and manage the ESD related complication. clin endosc 2019;52:114-119

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“…ESD for duodenal lesions have recently been shown to benefit from complete closure[143] as the risk of post ESD delayed bleeding and more importantly, delayed perforation (possibly caused by the high concentration of bile and digestive enzymes) can be catastrophic. Complete closure for colonic ESD is also being employed by expert centers who have reported accelerated mucosal healing[144], decreased delayed bleeding[145], as well as decreased need for post-ESD hospitalization[146]. For many of these larger closures, suturing is emerging as an alternative to clip closure[147].…”

Section: Early Gastric Cancer and Submucosal Tumors (Smts) Of The Stomentioning

confidence: 99%

Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

Chang

2019

WJG

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In this paper, I reviewed the emerging field of endoscopic surgery and present data supporting the contention that endoscopy can now be used to treat many foregut diseases that have been traditionally treated surgically. Within each topic, the content will progress as follows: “lessons learned”, “technical considerations” and “future opportunities”. Lessons learned will provide a brief background and update on the most current literature. Technical considerations will include my personal experience, including tips and tricks that I have learned over the years. Finally, future opportunities will address current unmet needs and potential new areas of development. The foregut is defined as “the upper part of the embryonic alimentary canal from which the pharynx, esophagus, lung, stomach, liver, pancreas, and part of the duodenum develop”. Foregut surgery is well established in treating conditions such as gastroesophageal reflux disease (GERD), achalasia, esophageal diverticula, Barrett’s esophagus (BE) and esophageal cancer, stomach cancer, gastric-outlet obstruction, and obesity. Over the past decade, remarkable progress in interventional endoscopy has culminated in the conceptualization and practice of endoscopic foregut surgery for various clinical conditions summarized in this paper. Regarding GERD, there are now several technologies available to effectively treat it and potentially eliminate symptoms, and the need for long-term treatment with proton pump inhibitors. For the first time, fundoplication can be performed without the need for open or laparoscopic surgery. Long-term data going out 5-10 years are now emerging showing extended durability. In respect to achalasia, per-oral endoscopic myotomy (POEM) which was developed in Japan, has become an alternative to the traditional Heller’s myotomy. Recent meta-analysis show that POEM may have better results than Heller, but the issue of post-POEM GERD still needs to be addressed. There is now a resurgence of endoscopic treatment of Zenker’s diverticula with improved technique (Z-POEM) and equipment; thus, patients are choosing flexible endoscopic treatment as opposed to open or rigid endoscopy options. In regard to BE, endoscopic submucosal dissection (ESD) which is well established in Asia, is now becoming more mainstream in the West for the treatment of BE with high grade dysplasia, as well as early esophageal cancer. In combination with all the ablation technologies (radiofrequency ablation, cryotherapy, hybrid argon plasma coagulation), the entire spectrum of Barrett’s and related dysplasia and early cancer can be managed predominantly by endoscopy. Importantly, in regard to early gastric cancer and submucosal tumors (SMTs) of the stomach, ESD and full thickness resection (FTR) can excise these lesions en-bloc and endoscopic suturing is now used to close large defects and perforations. For treatment of patients with malignant gastric outlet obstruction (GOO), endoscopic gastro-jejunostomy is now showing better results ...

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Prophylactic clip closure may reduce the risk of delayed bleeding after colorectal endoscopic submucosal dissection

Cited by 33 publications

References 30 publications

Feasibility of endoscopic suturing to prevent adverse events and hospitalization after endoscopic submucosal dissection

Feasibility of endoscopic suturing to prevent adverse events and hospitalization after endoscopic submucosal dissection

Management of Complications of Colorectal Submucosal Dissection

Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

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