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Research Article|Articles in Press

Novel Through-the-Scope Suture Closure of Colonic Endoscopic Mucosal Resection Defects

Published:March 06, 2023DOI:https://doi.org/10.1016/j.gie.2023.02.031
Novel Through-the-Scope Suture Closure of Colonic Endoscopic Mucosal Resection Defects
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      ABSTRACT

      Background and Aims

      Large colon polyps removed by endoscopic mucosal resection (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 suture (TTSS) device allows direct closure of mucosal defects without scope withdrawal. We aim to evaluate the rate of delayed bleeding following the closure of large colon polyp EMR sites with TTSS.

      Methods

      A multi-center retrospective cohort study was performed involving 13 centers. All defect closure by TTSS following 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 (F= 52%, mean age 65 years) underwent EMR of predominantly right sided (n=62, 66%) colon polyps (median size 35 mm, IQR 30-40) 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 TTSC (n=32, 34%), using a median of 1 (IQR 1-1) TTSS systems. Delayed bleeding occurred in three patients (3.2%) with two requiring repeat endoscopic evaluation/treatment (moderate).

      Conclusion

      TTSS alone or with TTSC was effective in achieving complete closure of all post-EMR defects, despite a large lesion size. Following 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.

      Abbreviations:

      EMR (Endoscopic mucosal resection), ASA (American Society of Anaesthesiologist), TTSC (Through-the-scope clips), OTSS (Over-the-scope sutures), OTSC (Over-the-scope clips), SD (Standard deviation), IQR (Interquartile range)
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      Article info

      Publication history

      Accepted: February 23, 2023
      Received in revised form: February 7, 2023
      Received: October 18, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Funding: None

      Financial Disclosures:

      •Stuart R. Gordon is a consultant for Boston Scientific

      •Peter Draganov is a consultant for Olympus, Boston Scientific, Cook Medical, Fujifilm, and Medtronic

      •Saowanee Ngamruengphong is a consultant for Boston Scientific, Olympus and Neptune Medical.

      •Andrew Storm is a consultant for ERBE and Olympus and receives grant/research support from Apollo Endosurgery, Boston Scientific, Endo-Trans-Abdominal Gastric Surgical System, Endogenex, and Enterasense

      •Heiko Pohl receives grant/ research support from Steris and Cosmo

      •Jonathan Buscaglia is a speaker for Abbvie Inc and Boston Scientific

      •Lionel D’Souza is a consultant for Olympus and Apollo Endosurgery

      •Nikhil Kumta is a consultant for Boston Scientific, Olympus, SafeHeal, and Intuitive Consulting and is a speaker for Apollo Endosurgery

      •Anand Kumar is consultant for Olympus

      •Gregory Haber is a consultant for Boston Scientific, Microtech and Medtronic, speaker for Olympus and receives grant/research support from Fujifilm

      •Aihara Hiroyuki is a consultant for Olympus, Boston Scientific, Fujifilm, ConMed, 3D Matrix, and Medtronic

      •Mandeep Sawhney is a stock shareholder in Allurion Inc

      •Tyler Berzin is a consultant for Boston Scientific, Medtronic, Magentiq Eye, Wision AI and is a member of the advisory committees/review panel for Docbot AI

      •Mouen A. Khashab is a consultant for Boston Scientific, Olympus America, Medtronic, Apollo Endosurgery, Pentax and GI Supply, and receives royalties from UpToDate and Elsevier

      Acknowledgements: None

      Author Contributions

      DB: Collection, analysis and interpretation of the data and drafting of the manuscript.

      LYZ: Collection, analysis and interpretation of the data and drafting of the manuscript.

      MA: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      AS: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      JF: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      TM: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      KA: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      JAA: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      SS: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      SRG: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      JMA: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      MR: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      PVD: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      YND: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      BS: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      ZM: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      AS: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      SY: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      AA: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      NY: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      RT: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      MB: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      BG: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      HR: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      AC: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      SN: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      ACS: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      SS: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      HP: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      JCB: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      JMB: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      LSD: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      BQ: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      NAK: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      AK: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      GBH: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      AH: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      MS: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      RK: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      TMB: Collection of data, critical revision for important intellectual content and final approval of the manuscript.

      MAK: Conception, design, critical revision for important intellectual content, and final approval of the manuscript.

      Identification

      DOI: https://doi.org/10.1016/j.gie.2023.02.031

      Copyright

      © 2023 by the American Society for Gastrointestinal Endoscopy

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