High Rates of Defect Closure After Resection of Large Nonpedunculated Colorectal Lesions Using a Through-The-Scope...

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Medical Device Innovation

Background:

• Complete closure of mucosal defects post-gastrointestinal lesion resection is crucial for preventing delayed bleeding.
• Conventional through-the-scope clips (TTSC) face challenges in achieving complete closure for large defects.
• A novel TTSC with anchor prongs has been developed to better approximate margins of larger defects.

Purpose of the Study:

• To evaluate the efficacy of prophylactic complete closure using TTSC with anchor prongs.
• The study focused on large (≥ 20 mm) nonpedunculated colorectal lesions (LNPCLs) undergoing polypectomy, endoscopic mucosal resection (EMR), or endoscopic submucosal dissection (ESD).

Main Methods:

• A multicenter, single-arm prospective cohort study was conducted.
• The TTSC with anchor prongs was used for prophylactic closure after EMR/polypectomy or ESD for LNPCLs.
• Patients were monitored for 30 days, with primary outcomes including complete defect closure rate, delayed bleeding, and serious adverse events (SAEs).

Main Results:

• Ninety-nine out of 105 (94.3%) defects achieved complete closure.
• Complete closure rates were 93.0% for EMR/polypectomy and 100.0% for ESD.
• Delayed bleeding occurred in 1.9% of patients, and 7.6% experienced SAEs.

Conclusions:

• The TTSC with anchor prongs demonstrated a high rate (94%) of complete defect closure for LNPCLs.
• The incidence of delayed bleeding following prophylactic closure was low (1.9%).
• A randomized controlled trial is underway to further assess clinical outcomes.