A novel through-the-scope helix tack-and-suture device for mucosal defect closure following colorectal endoscopic submucosal dissection: a multicenter study

Abstract

Background: Complete closure of large mucosal defects following colorectal ESD with through-the-scope clips (TTSC) is oftentimes not possible. We aimed to report an early experience of using a novel through-the-scope suturing system (TTSS) for closing large mucosal defects after colorectal ESD. Methods: We performed a retrospective, multi-center cohort study of consecutive patients who underwent attempted prophylactic defect closure using TTSS after colorectal ESD. The primary outcome was technical success in achieving complete defect closure, defined as (<5mm) residual mucosal defect in the closure line using TTSS with or without adjuvant TTSC. Results: Eighty-two patients with a median defect size of 30 mm [25-40] were included. Technical Success was achieved in 92.7% (n=76) using TTSS only in 44(53.7%) and a combination of TTSS to approximate the widest segment followed by complete closure with TTSCs in 32(39%) patients. Incomplete/partial closure, failure of appropriate TTSS deployment, and need for over-the-scope salvage closure methods were observed in 7.3%(n=6). One intraprocedural bleed, 1 delayed bleed, and 3 intraprocedural perforations were observed. There were no adverse events related to the placement of TTSS. Conclusion: TTSS is an effective and safe tool for the closure of large mucosal defects after colorectal ESD and is an alternative when complete closure with TTSC alone is not possible.

Risk of delayed bleeding after colorectal endoscopic submucosal dissection: the Limoges Bleeding Score

“…The effect on CSDB of new topical agents and closing systems is not supported by a high level of evidence [25,26,27,28]. Our results will help the design of a randomized trial investigating the efficacy of these new devices, one that enrolls patients at high risk of CSDB.…”

Novel devices for third‐space endoscopy procedures

“…38,39 After defect closure with TTS suturing, delayed bleeding after colonic ESD and EMR were reported in 1.2% and 3.2%, respectively. 38,39 TTS suturing has also been shown to be effective for mucosal incision closure after esophageal POEM and G-POEM. 35,40 Furthermore, preliminary data from our group suggests that TTS suturing may be associated with less procedure time and similar closure rates when compared with the Overstitch for mucosotomy closure during G-POEM.…”

Helix tack-and-suture device for mucosal defect closure following colorectal endoscopic submucosal dissection: is it ready for global adoption?

“…Farha et al reported the use of a novel through-the-scope (TTS) helix tack-and-suture device for the closure of large mucosal defects after colorectal endoscopic submucosal dissection (ESD; median lesion size 30 mm, interquartile range [IQR] 25–40 mm) 1 . Technical success was achieved in 92.7 % of patients, with a median closure time of 10 minutes (IQR 6.3–17.3 minutes).…”