Prophylactic Suturing Closure Is Recommended after Endoscopic Treatment of Colorectal Tumors in Patients with Antiplatelet/Anticoagulant Therapy

Sakurai, Toshiharu; Adachi, Teppei; Kono, Masashi; Arizumi, Tadaaki; Kamata, Ken; Minaga, Kosuke; Yamao, Kentaro; Komeda, Yoriaki; Takenaka, Mamoru; Hagiwara, Satoru; Watanabe, Tomohiro; Nishida, Naoshi; Kashida, Hiroshi; Kudo, Masatoshi

doi:10.1159/000481226

Cited by 7 publications

(7 citation statements)

References 3 publications

(3 reference statements)

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“…Adverse events (AEs) related to endoscopic tissue resection include perforation and bleeding. Previous studies have reported decreased post-procedure bleeding and perforation with use of resection site closure [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal defect closure using a novel through-the-scope helix tack and suture device compared to endoscopic clips in a survival porcine model (with video)

et al. 2021

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Background and aims Endoscopic resections are associated with bleeding and perforation and may be managed with through-the-scope (TTS) clips, over-the-scope clips and endoscopic suturing. The aim of this preclinical study was to compare technical success of closure using a novel TTS tissue helix tack and suture device (X-Tack) to TTS clips in a porcine model. Materials and methods Four subjects underwent 40 mucosal resections, diameter range 25–50 mm, in the stomach (n = 24) and colon (n = 16). Closures were randomized to X-Tack (n = 24) or clip (n = 16). Animals underwent weekly endoscopic follow-up for 4 weeks. Results Technical closure with X-Tack was successful in 24 of 24 (100 %) cases and with clips in 13 of 16 cases (81.3 %) (P = 0.0001). One colonic perforation occurred and was successfully managed using X-Tack. The rate of healing was not statistically different between the groups, and all sites healed at 4 weeks including the perforation and were confirmed by histology. Conclusions Compared to TTS clip, X-Tack is superior for effecting large mucosal defect closure, including durable sealing of full-thickness perforation. There was no difference in rate of healing between devices.

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Section: Introductionmentioning

confidence: 99%

Gastrointestinal defect closure using a novel through-the-scope helix tack and suture device compared to endoscopic clips in a survival porcine model (with video)

et al. 2021

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“…Furthermore, several previous studies reported that closure of mucosal defects with clips after EMR for large colorectal lesions decreased the risk of bleeding after ER [39,40]. Several techniques, such as endoloop [41], hand-suturing [42], OverStitch endoscopic suturing [43], 8ring [44], mucosal incision [45], over-the-scope clip [46], and two-channel techniques [47], for complete closure of large, resected ulcers after ER have been demonstrated. The tissue shielding method using a polyglycolic acid (PGA) sheet and fibrin glue may effectively prevent bleeding.…”

Section: Discussionmentioning

confidence: 99%

Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching Analysis

Inagaki

Yamashita

Oka

et al. 2021

Gastroenterology Research and Practice

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The Japan Gastroenterological Endoscopy Society (JGES) guidelines recommend continued warfarin treatment during gastroenterological endoscopic procedures with a high risk of bleeding as an alternative to heparin replacement in patients on warfarin therapy. However, there is insufficient evidence to support the use of warfarin in colorectal endoscopic resection (ER). The present study is aimed at verifying the risk of bleeding after ER for colorectal neoplasia (CRN) in patients with continued warfarin use. This was a single-center retrospective cohort study using clinical records. We assessed 126 consecutive patients with 159 CRNs who underwent ER (endoscopic mucosal resection, 146 cases; endoscopic submucosal dissection, 13 cases) at Hiroshima University Hospital between January 2014 and December 2019. Patients were divided into two groups: the heparin replacement group (79 patients with 79 CRNs) and the continued warfarin group (47 patients with 80 CRNs). One-to-one propensity score matching was performed to compare the bleeding rate after ER between the groups. The rate of bleeding after ER was significantly higher in the heparin replacement group than in the continued warfarin group for both before (10.1% vs. 1.3%, respectively; P = 0.0178 ) and after (11.9% vs. 0%, respectively; P = 0.0211 ) propensity score matching. None of the patients experienced thromboembolic events during the perioperative period. The risk of bleeding after colorectal ER was significantly lower in patients with continued warfarin use than in those with heparin replacement. Our data supports the recommendations of the latest JGES guidelines for patients receiving warfarin therapy.

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“…been reported [51][52][53][54][55]. These techniques should only be used in complex clipping cases by expert endoscopists.…”

Section: Tts Clipmentioning

confidence: 99%

“…allow adequate closure of large lesions will likely become standard practice, competing with the expensive treatment with large-diameter clips. Case reports and series have reported several of these techniques, using clips in combination with snares and nylon lines [51][52][53]55,58].…”

Section: Improvementmentioning

confidence: 99%

Clips for managing perforation and bleeding after colorectal endoscopic mucosal resection

Turan

Ultee

Geenen

et al. 2019

Expert Review of Medical Devices

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Introduction: The most commonly used treatment for advanced colorectal adenomas is endoscopic mucosal resection (EMR). The increased number of EMRs since the introduction of the screening program for colorectal cancer has resulted in an increase in EMR-related complications. This review summarizes the current knowledge for the use of clips for the treatment and prevention of complications after EMR. Areas covered: The historical development of clips is summarized and their properties are evaluated. An overview is presented of the evidence for therapeutic and prophylactic clipping for bleeding or perforation after EMR in the colon. Several clipping techniques are discussed in relation to the efficacy of wound closure. Furthermore, new techniques that will likely influence the use of clips in the future endoscopic practice, such as endoscopic full-thickness resection (eFTR) are also highlighted. Expert commentary: Most research focuses on prophylactic clipping for delayed bleeding after EMR of large adenomas. We advocate a distance of 0.5-1.0 cm between aligning clips. This focus may likely shift from bleeding to perforation. Here, endoscopic treatment with through-the-scope clips and largediameter clips may well replace surgery. The future role of clips will also depend on the further development of new endoscopic technologies, such as eFTR.

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Prophylactic Suturing Closure Is Recommended after Endoscopic Treatment of Colorectal Tumors in Patients with Antiplatelet/Anticoagulant Therapy

Cited by 7 publications

References 3 publications

Gastrointestinal defect closure using a novel through-the-scope helix tack and suture device compared to endoscopic clips in a survival porcine model (with video)

Gastrointestinal defect closure using a novel through-the-scope helix tack and suture device compared to endoscopic clips in a survival porcine model (with video)

Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching Analysis

Clips for managing perforation and bleeding after colorectal endoscopic mucosal resection

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