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Closure of Mucosal Defects Using Endoscopic Suturing Following Endoscopic Submucosal Dissection: A Single-Center
Osman Ali1, Andrew Canakis1, Yuting Huang2
1Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, MD.
Techniques and Innovations in Gastrointestinal Endoscopy
|October 6, 2023
Summary
Endoscopic suturing after endoscopic submucosal dissection (ESD) safely closes large defects, minimizing complications like bleeding and perforation. This method reduces hospitalizations, offering a reliable solution for gastrointestinal neoplasm treatment.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
Background:
- Endoscopic submucosal dissection (ESD) resects gastrointestinal neoplasms but creates large defects.
- These defects pose risks of adverse events, including delayed bleeding and perforation.
- Endoscopic mucosal resection (EMR) has lower en-bloc resection rates and higher local recurrence than ESD.
Purpose of the Study:
- To evaluate clinical outcomes of endoscopic suturing for mucosal defect closure after ESD.
- To assess the incidence of delayed bleeding, perforation, and hospitalization following ESD with endoscopic suturing.
Main Methods:
- Retrospective analysis of a prospectively collected database.
- Inclusion of adult patients undergoing ESD with endoscopic suturing for defect closure.
- Primary outcome assessment focused on delayed bleeding and perforation; secondary outcomes included hospitalization and suturing complications.
Main Results:
- 55 patients with a mean lesion size of 27.4 mm underwent defect closure.
- Hospital admission rate was 14% (average stay: 2 days).
- Two intra-procedure perforations were successfully managed with suturing; one delayed bleeding case occurred. No delayed perforations or suturing complications were reported.
Conclusions:
- Endoscopic suturing is a safe and effective method for closing mucosal defects post-ESD.
- This technique is associated with low rates of adverse events and hospitalization.
- Further large-scale studies are recommended to confirm these findings.
