Novel through-the-scope suture closure of colonic EMR defects (with video).

Aged Female Humans Male Colon / surgery Colonic Polyps / pathology Colonoscopy / methods Endoscopic Mucosal Resection / adverse effects Postoperative Hemorrhage / epidemiology Retrospective Studies Surgical Instruments

Journal

Gastrointestinal endoscopy

ISSN: 1097-6779

Titre abrégé: Gastrointest Endosc

Pays: United States

ID NLM: 0010505

Informations de publication

Date de publication:
07 2023

Historique:

received: 18 10 2022

revised: 07 02 2023

accepted: 23 02 2023

medline: 20 6 2023

pubmed: 9 3 2023

entrez: 8 3 2023

Statut: ppublish

Résumé

Large colon polyps removed by EMR can be complicated by delayed bleeding. Prophylactic defect clip closure can reduce post-EMR bleeding. Larger defects can be challenging to close using through-the-scope clips (TTSCs), and proximal defects are difficult to reach using over-the-scope techniques. A novel, through-the-scope suturing (TTSS) device allows direct closure of mucosal defects without scope withdrawal. The goal of this study was to evaluate the rate of delayed bleeding after the closure of large colon polyp EMR sites with TTSS. A multicenter retrospective cohort study was performed involving 13 centers. All defect closure by TTSS after EMR of colon polyps ≥2 cm from January 2021 to February 2022 were included. The primary outcome was rate of delayed bleeding. A total of 94 patients (52% female; mean age, 65 years) underwent EMR of predominantly right-sided (n = 62 [66%]) colon polyps (median size, 35 mm; interquartile range, 30-40 mm) followed by defect closure with TTSS during the study period. All defects were successfully closed with TTSS alone (n = 62 [66%]) or with TTSS and TTSCs (n = 32 [34%]), using a median of 1 (interquartile range, 1-1) TTSS system. Delayed bleeding occurred in 3 patients (3.2%), with 2 requiring repeated endoscopic evaluation/treatment (moderate). TTSS alone or with TTSCs was effective in achieving complete closure of all post-EMR defects, despite a large lesion size. After TTSS closure with or without adjunctive devices, delayed bleeding was seen in 3.2% of cases. Further prospective studies are needed to validate these findings before wider adoption of TTSS for large polypectomy closure.

Sections du résumé

BACKGROUND AND AIMS

METHODS

A multicenter retrospective cohort study was performed involving 13 centers. All defect closure by TTSS after EMR of colon polyps ≥2 cm from January 2021 to February 2022 were included. The primary outcome was rate of delayed bleeding.

RESULTS

A total of 94 patients (52% female; mean age, 65 years) underwent EMR of predominantly right-sided (n = 62 [66%]) colon polyps (median size, 35 mm; interquartile range, 30-40 mm) followed by defect closure with TTSS during the study period. All defects were successfully closed with TTSS alone (n = 62 [66%]) or with TTSS and TTSCs (n = 32 [34%]), using a median of 1 (interquartile range, 1-1) TTSS system. Delayed bleeding occurred in 3 patients (3.2%), with 2 requiring repeated endoscopic evaluation/treatment (moderate).

CONCLUSION

TTSS alone or with TTSCs was effective in achieving complete closure of all post-EMR defects, despite a large lesion size. After TTSS closure with or without adjunctive devices, delayed bleeding was seen in 3.2% of cases. Further prospective studies are needed to validate these findings before wider adoption of TTSS for large polypectomy closure.

Identifiants

DOI: 10.1016/j.gie.2023.02.031 PMID: 36889364

pubmed: 36889364

pii: S0016-5107(23)00300-0

doi: 10.1016/j.gie.2023.02.031

pii:

doi:

Types de publication

Video-Audio Media Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

122-129

Commentaires et corrections

Type : CommentIn