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The Pocket-Creation Procedure of Endoscopic Submucosal Dissection for Large Rectal Laterally Spreading Tumors

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Indications and Techniques for Closure after Endoscopic Mucosal Resection.

Muhammad Salman Faisal¹, Mazen Elatrache¹, Tobias Zuchelli¹

¹Division of Gastroenterology and Hepatology, Henry Ford Health System, K7, 2799 W. Grand Boulevard, Detroit, MI 48202, USA.

Gastrointestinal Endoscopy Clinics of North America

|March 29, 2026

Summary

This summary is machine-generated.

Endoscopic mucosal resection defect closure is crucial, especially after hot snare resection in the duodenum and right colon, to prevent delayed bleeding. Various endoscopic clips and devices offer effective closure options for different defect sizes.

Keywords:

Cold snare resection Endoscopic closure Endoscopic mucosal resection Hot snare resection Over the scope clip Through the scope clip

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Area of Science:

Gastroenterology
Endoscopic Surgery

Background:

Endoscopic mucosal resection (EMR) is a common technique for removing gastrointestinal lesions.
Delayed bleeding is a significant complication following EMR, particularly with certain resection methods and locations.

Purpose of the Study:

To determine the necessity of defect closure after EMR.
To review available endoscopic closure techniques for EMR defects.

Main Methods:

Review of factors influencing the need for closure after EMR.
Description of endoscopic closure devices and their applications.

Main Results:

Hot snare EMR generally requires closure to mitigate delayed bleeding risk.
The duodenum and right colon are high-risk locations for bleeding post-EMR.
Through-the-scope clips are suitable for most defects.
Over-the-scope clips and endoscopic suturing provide durable closure for larger defects.

Conclusions:

Endoscopic closure is often necessary after hot snare EMR, particularly in specific anatomical locations.
A range of endoscopic closure devices are available to manage defects of varying sizes, ensuring patient safety.