Tanabe Mayo, Inoue Haruhiro, Shimamura Yuto, Toshimori Akiko, Navarro Marc Julius Hernandez, Fujiyoshi Yusuke, Fujiyoshi Mary Raina Angeli, Shiomi Daijiro, Kishi Yumi, Ushikubo Kei, Nishikawa Yohei, Onimaru Manabu, Ito Takayoshi, Uragami Naoyuki, Yokoyama Noboru
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan.
Digestive Diseases Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
Endosc Int Open. 2024 Aug 8;12(8):E947-E954. doi: 10.1055/a-2362-5617. eCollection 2024 Aug.
Mucosal defect closure after colorectal endoscopic submucosal dissection (ESD) has the potential to reduce the occurrence of delayed adverse events (AEs) such as bleeding and perforation. This study aimed to assess the feasibility and effectiveness of the Loop9 method for closing mucosal defects following colorectal ESD. A retrospective single-center study was conducted using prospectively collected data from May 2020 to March 2023. Loop9 was deployed through a single instrument channel and anchored with clips at the defect site. Closure was accomplished by tightening the loop and deploying additional conventional clips as needed for complete closure. The primary outcome was complete closure rate, with secondary outcomes including the sustained closure rate at 4 to 5 days post-ESD, closed defect size, closure time, number of additional clips, and incidence of delayed AEs. This study included 118 cases. Complete closure was achieved in 96.6% of cases (114/118) with a sustained closure rate of 93.9% (107/114). The median size of the closed mucosal defects was 30 mm (interquartile range [IQR]: 25-38, range: 15-74). The median closure time was 14 minutes (IQR: 11.25-17), and the median number of additional clips deployed was six (IQR: 4-7). Stenosis requiring balloon dilatation was observed in one patient; however, there were no instances of post-ESD bleeding or delayed perforation. The Loop9 method proved feasible and effective for closing mucosal defects following colorectal ESD, achieving high rates of complete and sustained closure.
结直肠内镜黏膜下剥离术（ESD）后黏膜缺损的闭合有可能减少出血和穿孔等延迟性不良事件（AE）的发生。本研究旨在评估Loop9方法在结直肠ESD后闭合黏膜缺损的可行性和有效性。使用2020年5月至2023年3月前瞻性收集的数据进行了一项回顾性单中心研究。Loop9通过单个器械通道部署，并在缺损部位用夹子固定。通过收紧环并根据需要部署额外的传统夹子来完成闭合。主要结局是完全闭合率，次要结局包括ESD后4至5天的持续闭合率、闭合缺损大小、闭合时间、额外夹子数量和延迟性AE的发生率。本研究纳入了118例病例。96.6%的病例（114/118）实现了完全闭合，持续闭合率为93.9%（107/114）。闭合黏膜缺损的中位大小为30 mm（四分位间距[IQR]：25 - 38，范围：15 - 74）。中位闭合时间为14分钟（IQR：11.25 - 17），额外部署的夹子中位数量为6个（IQR：4 - 7）。1例患者观察到需要球囊扩张的狭窄；然而，没有ESD后出血或延迟穿孔的情况。Loop9方法被证明在结直肠ESD后闭合黏膜缺损是可行且有效的，实现了高完全闭合率和持续闭合率。
