Background and Aims
Several ligation techniques for ulceration after endoscopic submucosal dissection
(ESD) have been reported, but none have been established for clinical use because
of technical complexity and the need for expensive equipment. Therefore, the technical
feasibility of a new ligation method using the double-loop clips (D-L clips) technique
without an adhesive agent for ulceration after ESD of the colon was assessed.
Methods
Among 35 patients who underwent ESD of the colon in Kushiro Rosai Hospital between
April 2019 and September 2019, 26 patients who underwent ligation using the D-L clips
technique for the post-ESD ulcer bed were included in this retrospective study. Continuation
or cessation of antithrombotic agents was based on the Guidelines for Gastroenterological
Endoscopy in Patients Undergoing Antithrombotic Treatment.
Results
The rate of en bloc R0 resection was 97.1%, the median length of the resected specimen
was 3.2 cm (interquartile range [IQR], 2.8-3.8 cm), and the complete ligation rate
was 88.5% (23 of 26). Excluding patients with lesion sites in the rectum below the
peritoneal reflection, the complete ligation rate was 95.5% (21 of 22). The median
duration of the ligation procedure was 20 minutes (IQR, 16-24 minutes). The only delayed
procedural adverse event was post-ESD coagulation syndrome in 1 patient. Incomplete
ligation was significantly more frequent in patients with lesion sites in the inferior
rectal valve/anal verge area (P = .0269).
Conclusions
Ligation using the D-L clips technique without an adhesive agent is feasible for closing
ulceration after ESD of the colon, whereas other techniques may be necessary for lesions
in the rectum below the peritoneal reflection.
Graphical abstract
Graphical Abstract
Abbreviations:
D-L clips (Double-loop clips), ESCS (endoscopic string clip suturing), ESD (endoscopic submucosal dissection), IQR (interquartile range), LACC (line-assisted complete closure), PECS (post-ESD electrocoagulation syndrome)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 19, 2020
Accepted:
February 2,
2020
Received:
October 16,
2019
Footnotes
DISCLOSURE: All authors are full-time employees of Kushiro Rosai Hospital.
Identification
Copyright
© 2020 by the American Society for Gastrointestinal Endoscopy
