Endoloop closure following gastric endoscopic submucosal dissection to prevent delayed bleeding in patients receiving antithrombotic therapy

Endoscopic Delivery of Polymers Reduces Delayed Bleeding after Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis

“…However, in studies comparing the efficacy of prevention of delayed bleeding using endoscopic closure (RR 0.60, 95% CI 0.27-1.32; I 2 = 43%, p = 0.150) with control groups, no statistically significant difference was found (Figure 2). [32,33,38,41]; (B) Tissue shielding group vs. control group [10,[43][44][45][46]; (C) Hemostatic spray group vs. control group. Block and whisker: point estimate and 95% confidence interval (CI) of the primary study.…”

“…Of the total, 54 proved potentially relevant for full-text review. Of these, 31 articles on the management of ESD-induced ulcers via endoscopic closure (hemoclips, endoclips, endoloop + endoclips, detachable snare + clips, OTSC + through-the-scope clips [TTSC], overstitch suturing, handsewn suturing) [31][32][33][34][35][36][37][38][39][40][41][42], tissue shielding methods (PGA sheets-based) [10,[43][44][45][46][47][48][49], and hemostatic powder/gel spray [18,19,[50][51][52][53][54][55][56][57][58], matched the selection criteria and were included in the systematic review. The key characteristics of each included study appear in Table 1.…”

“…Thus, a network was created among the nodes of the three categorized endoscopic approaches (endoscopic closure, tissue shielding method, and hemostatic spray) with a control group node (Figure 3A). Overall, 2742 lesions were randomly assigned to one of [32,33,38,41]; (B) Tissue shielding group vs. control group [10,[43][44][45][46]; (C) Hemostatic spray group vs. control group. Block and whisker: point estimate and 95% confidence interval (CI) of the primary study.…”

“…Figure 2.The efficacy of different endoscopic approaches for the prevention of delayed bleeding after gastric ESD, according to pair-wise meta-analysis: (A) Endoscopic closure group vs. control group[32,33,38,41]; (B) Tissue shielding group vs. control group[10,[43][44][45][46]; (C) Hemostatic spray group vs. control group. Block and whisker: point estimate and 95% confidence interval (CI) of the primary study.…”

Successful mucosal closure of artificial gastric ulcer with twin grasping forceps and endoclips after endoscopic submucosal dissection

“…The risk of postoperative adverse events following endoscopic resection can be reduced through endoscopic closure of the artificial gastric ulcer [1], but it is not easy owing to the gastric wall thickness and hardness. There are several methods for closing ulcers induced by gastric endoscopic submucosal dissection (ESD) [2][3][4][5]. Here, we describe the successful simple closure of a post-gastric ESD artificial ulcer using twin grasping forceps (Twin Grasper; Ovesco Endoscopy AG, Tubingen, Germany) and endoclips (EZ clip; Olympus, Tokyo, Japan).…”