Mucosal colonic defect post EMR or ESD: to close or not?

Burgess, Nicholas G.; Bourke, Michael J.

doi:10.1055/s-0042-117220

Cited by 6 publications

(2 citation statements)

References 17 publications

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“…Proponents of closure cite less delayed bleeding and perforation as well as earlier discharge with associated decreased cost, but the data is limited to date[ 58 ]. Opponents argue that closure may complicate subsequent surveillance or further resection at the ESD site by creating artificial nodules or other “lesions” and/or burying residual neoplastic tissue and questionable cost-effectiveness[ 59 ]. Use of an omental patch may help in perforation closure either with clips or endoscopic sutures.…”

Section: Challeneges For Western Esd Operatormentioning

confidence: 99%

Introduction of endoscopic submucosal dissection in the West

Friedel¹,

Stavropoulos²

2018

WJGE

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Endoscopic submucosal dissection (ESD) is well established in Asia as a modality for selected advanced lesions of both the upper and lower gastrointestinal tract, but ESD has not attained the same niche in the West due to a variety of reasons. These include competition from traditional surgery, minimally invasive surgery and endoscopic mucosal resection. Other obstacles to ESD introduction in the West include time commitment for learning and doing procedures, a steep learning curve, special equipment, lack of mentors, cost issues, interdisciplinary conflicts, concern regarding complications and lack of support from institutions and interfacing departments. There are intrinsic differences in pathology prevalence (e.g., early gastric cancer) between the two regions that are less conducive for ESD implementation in the West. We will elaborate on these issues and suggest measures as well as a protocol to overcome these obstacles and hopefully allow introduction of ESD as a tenable option for appropriate patients.

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Section: Challeneges For Western Esd Operatormentioning

confidence: 99%

Introduction of endoscopic submucosal dissection in the West

Friedel¹,

Stavropoulos²

2018

WJGE

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“…However, as the study included not only ESD but also EMR cases, its limitation was its small sample size of ESD cases. Therefore, the hemostatic effect of prophylactic clip closure after only ESD remains controversial [10]. However, according to our data, including ESD-only cases, we revealed that prophylactic clip closure after ESD was associated with low delayed bleeding rate; therefore, we recommend that prophylactic clip closure should be performed also after ESD.…”

Section: Discussionmentioning

confidence: 61%

The efficacy of prophylactic clip closure of mucosal defects after colorectal endoscopic submucosal dissection on delayed bleeding

Miyakawa

Kuwai

Sakuma

et al. 2021

Scandinavian Journal of Gastroenterology

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Objective: Although prophylactic clip closure after endoscopic mucosal resection may prevent delayed bleeding, information regarding colorectal endoscopic submucosal dissection (CR-ESD) is lacking. Therefore, this study evaluated the effect of prophylactic clip closure on delayed bleeding rate after CR-ESD. Materials and methods: A total of 614 CR-ESD procedures performed in 561 patients were retrospectively reviewed. The primary outcome, which was delayed bleeding rate, was analyzed between the prophylactic clip closure and non-closure groups. Furthermore, the predictors of delayed bleeding were also evaluated. Results: The patients were divided into the clip closure group (n ¼ 275) and non-closure group (n ¼ 339). Delayed bleeding rate was significantly lower in the closure group than in non-closure group (6 cases [2.2%] vs. 20 cases [5.9%], p ¼ .026). The univariate logistic regression analyses revealed that delayed bleeding was significantly associated with laterally spreading tumor-granular-nodular mixed type (LST-G-Mix; odds ratio [OR], 3.77; 95% confidence interval [CI], 1.70-8.34; p ¼ .001). By contrast, prophylactic clip closure was significantly associated with low delayed bleeding rate (OR, 0.36; 95%CI, 0.14-0.90; p ¼ .029). The multivariate logistic regression analyses revealed LST-G-Mix as a significant independent delayed bleeding predictor (OR, 3.25; 95%CI,; p ¼ .004), whereas, prophylactic clip closure was identified as a significant independent preventive factor of delayed bleeding (OR, 0.39; 95%CI, 0.15-1.00; p ¼ .049). Conclusions: Prophylactic clip closure after CR-ESD is associated with low delayed bleeding rate. LST-G-Mix promotes delayed bleeding, and performing prophylactic clip closure may be advisable.

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