Endoscopic closure of the defect after endoscopic submucosal resection with metal clips and surgical sutures

Wang, Wei; Jin, Lü; Zhao, Fei; Qi, Ke; Jin, Zhendong

doi:10.1016/j.vgie.2018.09.007

Cited by 3 publications

(3 citation statements)

References 3 publications

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“…Currently, there are large through‐the‐scope clips, up to 16 mm in open width, available for closing large mucosal defects 39 . Besides, several new advanced techniques have been developed to close large defects, such as clip‐on‐clip closure method, 40 metal clips with surgical sutures, 41 string clip suturing method, 42 clip‐fixed endoloop, 43 and line‐assisted complete closure 44 . Endoscopists should employ more appropriate clips and advanced stitching techniques to achieve a higher defect closure rate when dealing with difficult LNPCLs.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic clipping after endoscopic mucosal resection of large nonpedunculated colorectal lesions: A meta‐analysis

Yang

Lee

et al. 2021

J of Gastro and Hepatol

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Background and Aim: It is not clear whether prophylactic clipping after endoscopic mucosal resection (EMR) of large nonpedunculated colorectal lesions (LNPCLs) prevents delayed bleeding (DB). We aimed to conduct a meta-analysis to clarify the efficacy of prophylactic clipping in prevention of DB following EMR of LNPCLs. Methods: We searched PubMed, EMBASE, Web of Science, ScienceDirect, Cochrane Library databases, and ClinicalTrials.gov for studies that compared clipping versus (vs) nonclipping in prevention of DB following EMR of LNPCLs. Pooled odds ratio (OR) was determined using a random effects model. The pooled ORs of DB, perforation, and post-polypectomy syndrome in the clipping group compared with the nonclipping group comprised the outcomes. Subgroup analyses based on study design, polyp location, and completeness of wound closure were performed. Results: Five studies with a total of 3112 LNPCLs were extracted. Prophylactic clipping reduced the risk of DB compared with nonclipping (3.3% vs 6.2%, OR: 0.494, P = 0.002) following EMR of LNPCLs. In subgroup analysis, prophylactic clipping reduced DB of LNPCLs at proximal location (3.8% vs 9.8%, P = 0.029), but not of them at distal location (P = 0.830). Complete wound closure showed superior efficacy to prevent DB compared with partial closure (2.0% vs 5.4%, P = 0.004). No benefit of clipping for preventing perforation or post-polypectomy syndrome was observed (P = 0.301 and 0.988, respectively). Conclusions: Prophylactic clipping can reduce DB following EMR of LNPCLs at proximal location. Besides, complete wound closure showed superior efficacy to prevent DB compared with partial closure. Further cost analyses should be conducted to implement the most cost-effective strategies.

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Section: Discussionmentioning

confidence: 99%

Prophylactic clipping after endoscopic mucosal resection of large nonpedunculated colorectal lesions: A meta‐analysis

Yang

Lee

et al. 2021

J of Gastro and Hepatol

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“…Post‐ER mucosal defect closure requires a single clip to grasp the defect edges, and several methods and devices have been proposed to bring the edges closer 29,31,32,34,37,74–88 . Recently, a new device using a reopenable clip with a ring has been devised 89 .…”

Section: Defect Closure Using Clips and Special Devicesmentioning

confidence: 99%

“…P OST-ER MUCOSAL DEFECT closure requires a single clip to grasp the defect edges, and several methods and devices have been proposed to bring the edges closer. 29,31,32,34,37,[74][75][76][77][78][79][80][81][82][83][84][85][86][87][88] Recently, a new device using a reopenable clip with a ring has been devised. 89 In existing reports, the clip and the ring were separated, and the ring could drop into the gastrointestinal tract when the clip was set under endoscopic view.…”

Section: Defect Closure Using Clips and Special Devicesmentioning

confidence: 99%

Suturing techniques with endoscopic clips and special devices after endoscopic resection

Nomura

Sugimoto

Temma

et al. 2022

Digestive Endoscopy

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Endoscopic submucosal dissection is an established method for complete resection of large and early gastrointestinal tumors. However, methods to reduce bleeding, perforation, and other adverse events after endoscopic resection (ER) have not yet been defined. Mucosal defect closure is often performed endoscopically with a clip. Recently, reopenable clips and large‐teeth clips have also been developed. The over‐the‐scope clip enables complete defect closure by withdrawing the endoscope once and attaching the clip. Other methods involve attaching the clip‐line or a ring with an anchor to appose the edges of the mucosal defect, followed by the use of an additional clip for defect closure. Since clips are limited by their grasping force and size, other methods, such as endoloop closure, endoscopic ligation with O‐ring closure, and the reopenable clip over‐the‐line method, have been developed. In recent years, techniques often utilized for full‐thickness ER of submucosal tumors have been widely used in full‐thickness defect closure. Specialized devices and techniques for defect closure have also been developed, including the curved needle and line, stitches, and an endoscopic tack and suture device. These clips and suture devices are applied for defect closure in emergency endoscopy, accidental perforations, and acute and chronic fistulas. Although endoscopic defect closure with clips has a high success rate, endoscopists need to simplify and promote endoscopic closure techniques to prevent adverse events after ER.

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Clip Closure After Resection of Large Colorectal Lesions With Substantial Risk of Bleeding

et al. 2019

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Endoscopic closure of the defect after endoscopic submucosal resection with metal clips and surgical sutures

Cited by 3 publications

References 3 publications

Prophylactic clipping after endoscopic mucosal resection of large nonpedunculated colorectal lesions: A meta‐analysis

Prophylactic clipping after endoscopic mucosal resection of large nonpedunculated colorectal lesions: A meta‐analysis

Suturing techniques with endoscopic clips and special devices after endoscopic resection

Clip Closure After Resection of Large Colorectal Lesions With Substantial Risk of Bleeding

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