Underwater Clip Closure versus Conventional Clip Closure following Endoscopic Submucosal Dissection in Colorectal...

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Surgery

Background:

• Endoscopic submucosal dissection (ESD) for colorectal lesions can result in post-procedural ulcers.
• Effective closure of these ulcers is crucial to prevent complications.
• Conventional clip closure (CCC) is a standard method, but faster techniques are sought.

Purpose of the Study:

• To compare the efficacy and safety of underwater clip closure (UCC) versus conventional clip closure (CCC) for post-ESD ulcers.
• To evaluate closure time, clip usage, and complication rates.

Main Methods:

• A retrospective study of 89 patients with colorectal lesions ≤5 cm treated with ESD.
• Comparison between UCC (n=52) and CCC (n=37) groups.
• Primary outcomes: complete closure rate, post-ESD coagulation syndrome (PECS), delayed bleeding, perforation. Secondary outcomes: closure time, clips used.

Main Results:

• Complete closure was achieved in all patients across both groups.
• No significant difference in PECS, delayed bleeding, or perforation was observed.
• Median closure time was significantly shorter with UCC (10 min) compared to CCC (11 min; p=0.044).
• The number of clips used was similar between UCC and CCC groups (median 10; p=0.290).
• Resection area and closure method were independent factors influencing closure time.

Conclusions:

• Underwater clip closure (UCC) may reduce the time needed for post-ESD closure of colorectal lesions ≤5 cm.
• UCC demonstrates comparable clip usage to CCC without increasing serious complications.
• UCC presents a potentially more time-efficient method for managing post-ESD colorectal ulcers.