Underwater reopenable clip closure of mucosal defects after duodenal endoscopic submucosal dissection

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is useful for en bloc resection of superficial colorectal neoplasms to ensure accurate histologic diagnoses. However, colorectal ESD is associated with a high frequency of adverse events (AEs). We aimed to investigate the effectiveness of prophylactic clip closure (PCC) of mucosal defects for AEs after colorectal ESD. Patients and methods This study included 197 patients with 211 lesions who underwent colorectal ESD between June 2010 and August 2016. Patients who had delayed perforation, delayed bleeding, abdominal pain, or fever were defined as AEs after colorectal ESD. Complete PCC was defined as completely sutured mucosal defect using endoclips following colorectal ESD, whereas incomplete PCC was defined as the mucosal defects that did not enable PCC or were partially sutured. Clinical records were retrospectively reviewed and clinical outcomes evaluated. Results AEs occurred in 29 lesions (13.7 %), including 12 with delayed bleeding, 12 with fever, 2 with abdominal pain, 2 with fever and abdominal pain, and 1 with delayed bleeding and fever. Delayed perforation was not observed in any patient. The frequency of AEs was significantly lower in the group with complete PCC than in the group with incomplete PCC (7.3 % [9/123] vs. 22.7 % [20/88]; P < 0.001). Multivariate analysis revealed that AEs after colorectal ESD were significantly associated with tumor size and submucosal fibrosis. Subgroup analysis among the resected specimen size of < 40 mm revealed that there was no significant difference in AEs between the 2 groups (5.6 % [6/107] vs. 17.8 % [8/45]; P = 0.069). However, the frequency of fever with complete PCC was significantly lower than that with incomplete PCC (2.8 % [3/107] vs. 13.3 % [6/45]; P = 0.020). Conclusions Tumor size and submucosal fibrosis were independent risk factors for AEs after colorectal ESD. PCC may be effective in minimizing AEs after colorectal ESD, especially the frequency of fever.

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Efficacy of mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection

World Journal of Gastrointestinal Endoscopy ◽

10.4253/wjge.v12.i1.17 ◽

2020 ◽

Vol 12 (1) ◽

pp. 17-22

Author(s):

Satoshi Kinoshita ◽

Toshihiro Nishizawa ◽

Ai Fujimoto ◽

Hideki Mori ◽

Yoshihiro Nakazato ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Submucosal Dissection ◽

Closure Method ◽

Clip Closure

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

Endoscopy International Open ◽

10.1055/a-0581-8886 ◽

2018 ◽

Vol 06 (05) ◽

pp. E582-E588 ◽

Cited By ~ 9

Author(s):

Hideharu Ogiyama ◽

Shusaku Tsutsui ◽

Yoko Murayama ◽

Shingo Maeda ◽

Shin Satake ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

Exact Test ◽

Delayed Bleeding ◽

Submucosal Dissection ◽

Student’S T ◽

Closure Group ◽

Clip Closure

Abstract Background and study aims Endoscopic submucosal dissection (ESD) has a high en bloc resection rate and is widely performed for large superficial colorectal tumors, but delayed bleeding remains one of the most common complications of colorectal ESD. The aim of the present study was to evaluate the clinical efficacy of prophylactic clip closure of mucosal defects for the prevention of delayed bleeding after colorectal ESD. Patients and methods We enrolled consecutive patients with colorectal lesions between January 2012 and May 2017 in this retrospective study. In the early part of this period, post-ESD mucosal defects were not closed (non-closure group); however, from January 2014, post-ESD mucosal defects were prophylactically closed with clips when possible (closure group). The main outcome measured was delayed bleeding. Variables were analyzed using the chi-squared test, Fisher’s exact test, or Student’s t-test. Results Of 156 lesions analyzed, 61 were in the non-closure group and 95 in the closure group. Overall, delayed bleeding occurred in 5 cases (3.2 %). The delayed bleeding rate was 0 % (0/95) in the closure group and 8.2 % (5/61) in the non-closure group (P = 0.008). The mean procedure time for closure was 10.4 ± 4.6 min (range 3 – 26 min). Conclusions We demonstrated that prophylactic clip closure of mucosal defects might reduce the risk of delayed bleeding after colorectal ESD.

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Endoscopic submucosal dissection combined with clip closure is effective to close gastrointestinal fistulas including refractory ones.

Endoscopy ◽

10.1055/a-1641-7938 ◽

2021 ◽

Author(s):

Pierre Lafeuille ◽

Timothee Wallenhorst ◽

Alexandru Lupu ◽

Jeremie Jacques ◽

Thomas Lambin ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Previous Attempt ◽

Success Rates ◽

Submucosal Dissection ◽

Endoscopic Closure ◽

Threatening Condition ◽

Life Threatening ◽

Clip Closure

ABSTRACT Objective: Gastrointestinal (GI) fistula, a life-threatening condition, represents a therapeutic challenge. Rescue surgery could be hazardous and/or impact quality of life justifying endoscopic con-servative approach including mucosal abrasion, clip closure or stent diversion with moderate success rates in the long term. We assessed whether Fistulas Endoscopic Submucosal Dissection with clip Closure (FESDC) could lead to complete resolution of fistulas even if previous endoscopic therapy failed. Results: 23 patients with GI fistulas were retrospectively included, 57% of those were defined as refractory fistulas since previous endoscopic treatment failed. Tight immediate sealing was obtained for 19 patients (83% [95% CI: 61%, 95%]) who received FESDC. Long term closure (>3 months) was obtained in 14 cases (61% [95% CI: 39%, 80%]) with a median follow-up of 20 months. Ad-verse events occurred in 9% of cases. Previous local malignancy (p=0.077) or radiation therapy (p=0.047) were associated with a higher risk of failure. Conclusion: The new FESDC strategy is safe and allows permanent endoscopic closure of GI fistulas in 61% of the patients, and 54% of those with previous attempt. Further studies are war-ranted to determine the place of this technic in the management of chronic GI fistula.

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