Clinical and technical outcomes of endoscopic closure of postendoscopic submucosal dissection defects: Literature review over one decade

Abstract

Endoscopic submucosal dissection (ESD), which enables curative en bloc resection of early gastrointestinal neoplasms, has been an attractive minimally invasive surgery during the past two decades. Large post‐ESD defects must be carefully managed to prevent adverse events (AEs). The major AEs comprise delayed bleeding (DB) and delayed perforation (DP), and overall AEs comprise DB plus DP. This review aimed to clarify the clinical efficacy and technical outcomes of endoscopic prophylactic closure for post‐ESD defects. We identified studies involving ≥10 patients up to March 2022 in which endoscopic closure was applied for gastric, duodenal, and colorectal post‐ESD defects. In the stomach, total rates of overall AEs and DB were significantly lower in the closure than non‐closure group. In the duodenum, total rates of overall AEs, DB, and DP were significantly lower in the closure group. In the colorectum, total rates of overall AEs and DB were significantly lower in the closure group. Closure techniques, categorized into three groups (clip‐based techniques, mechanical clipping, and surgical stitch‐based techniques), were illustrated. Endoscopic closure demonstrated a certain ability to reduce DB after gastric, duodenal, and colorectal ESD as well as DP after duodenal ESD. Considering closure‐associated costs, the indications and limitations of closure techniques should be further investigated.

Suturing techniques with endoscopic clips and special devices after endoscopic resection

“…With the development of ESD and EFTR, it has become possible to resect lesions en bloc. Postoperative adverse events can be prevented using clips and special devices for the closure of post‐ER mucosal and full‐thickness defects 125 . Researchers have gradually solved several problems associated with clip closure, including the reliability of methods, limitations on defect size, endoscopic maneuverability, cost‐effectiveness, and closure durability.…”

“…Postoperative adverse events can be prevented using clips and special devices for the closure of post-ER mucosal and full-thickness defects. 125 Researchers have gradually solved several problems associated with clip closure, including the reliability of methods, limitations on defect size, endoscopic maneuverability, cost-effectiveness, and closure durability. The rates of postoperative adverse events after ER have also been clarified for patients with different background risks.…”

Closure of a gastric endoscopic resection defect with a novel closure device

“…Closure of mucosal defects after endoscopic mucosal resection or endoscopic submucosal dissection (ESD) has been shown to reduce the risk of delayed bleeding and perforation 1 2 3 4 . Defect closure can be achieved using over-the-scope (OTS) clips, through-the-scope (TTS) clips, or endoscopic suturing 4 .…”

Clinical course and management of adverse events after endoscopic resection of superficial duodenal epithelial tumors: Multicenter retrospective study

“…Endoscopic resection of SDETs has a high AE risk owing to the thin duodenal wall and the exposure of pancreatic proteolytic enzymes to the wound 5 . Recently, reports have indicated that using several prophylactic closures and an endoscopic tissue shielding method for ER defects decreases the delayed AE risk 6–13 . However, AEs occurring after duodenal ER have a high surgical conversion risk, with reported rates of 3.5–66.7%, 0%, and 33.3–100% for intraoperative perforation, delayed bleeding, and delayed perforation after ESD, respectively, in Japan and East Asia 2,6–10,14–22 .…”