Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
Department of Gastroenterology, Vivantes Hospital Friedrichshain Berlin, Berlin, Germany.
Surg Endosc. 2023 Oct;37(10):7520-7529. doi: 10.1007/s00464-023-10235-2. Epub 2023 Jul 7.
Delayed bleeding is the most frequent complication after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) of large colon polyps. Today, prophylactic clipping with through-the-scope clips (TTSCs) is commonly used to reduce the risk of bleeding. However, the over-the-scope clip (OTSC) system might be superior to TTSCs in achieving hemostasis. This study aims to evaluate the efficacy and safety of prophylactic clipping using the OTSC system after ESD or EMR of large colon polyps.
This is a retrospective analysis of a prospective collected database from 2009 until 2021 of three endoscopic centers. Patients with large (≥ 20 mm) colon polyps were enrolled. All polyps were removed by either ESD or EMR. After the resection, OTSCs were prophylactically applied on parts of the mucosal defect with a high risk of delayed bleeding or/and perforation. The main outcome measurement was delayed bleeding.
A total of 75 patients underwent ESD (67%, 50/75) or EMR (33%, 25/75) in the colorectum. The mean resected specimen diameter was 57 mm ± 24.1 (range 22-98 mm). The mean number of OTSCs placed on the mucosal defect was 2 (range 1-5). None of the mucosal defects were completely closed. Intraprocedural bleeding occurred in 5.3% (ESD 2.0% vs. EMR 12.0%; P = 0.105), and intraprocedural perforation occurred in 6.7% (ESD 8% vs. EMR 4%; P = 0.659) of the patients. Hemostasis was achieved in 100% of cases of intraprocedural bleeding, whereas two patients required surgical conversion due to intraprocedural perforation. Among the remaining 73 patients who received prosphylactic clipping, delayed bleeding occurred in 1.4% (ESD 0% vs. EMR 4.2%; P = 0.329), and delayed perforation occurred in 0%.
The prophylactic partial closure of large post-ESD/EMR mucosal defects using OTSCs could serve as an effective strategy to reduce the risk of delayed bleeding and perforation. The prophylactic partial closure of large complex post-ESD/EMR mucosal defects using OTSCs could serve as an effective strategy to reduce the risk of delayed bleeding and perforation.
内镜黏膜下剥离术（ESD）和内镜黏膜切除术（EMR）切除大肠大息肉后，延迟性出血是最常见的并发症。目前，预防性夹闭术（通过内镜夹闭）常被用于降低出血风险。然而，过内镜夹（OTSC）系统在实现止血方面可能优于通过内镜夹闭。本研究旨在评估 OTSC 系统在 ESD 或 EMR 切除大肠大息肉后的预防性夹闭的疗效和安全性。
这是 2009 年至 2021 年三个内镜中心前瞻性收集数据库的回顾性分析。纳入大肠大息肉（≥20mm）患者。所有息肉均通过 ESD 或 EMR 切除。切除后，在有延迟性出血和/或穿孔高风险的黏膜缺损部位预防性应用 OTSC。主要观察指标为延迟性出血。
75 例患者行 ESD（67%，50/75）或 EMR（33%，25/75）治疗。切除标本的平均直径为 57mm±24.1（范围 22-98mm）。平均在黏膜缺损部位放置 2 个 OTSC（范围 1-5）。黏膜缺损未完全闭合。术中出血发生率为 5.3%（ESD 2.0%，EMR 12.0%；P=0.105），术中穿孔发生率为 6.7%（ESD 8%，EMR 4%；P=0.659）。术中出血的病例 100%止血成功，而有 2 例患者因术中穿孔需行手术转换。在其余 73 例接受预防性夹闭的患者中，迟发性出血发生率为 1.4%（ESD 0%，EMR 4.2%；P=0.329），迟发性穿孔发生率为 0%。
OTSC 对 ESD/EMR 后大的黏膜缺损进行部分预防性夹闭可作为降低迟发性出血和穿孔风险的有效策略。
