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DOI: 10.1055/a-2409-0175
A full-thickness defect: is closure the only way?
Closure is one of the standard steps during endoscopic full-thickness resection (EFTR) [1] [2]. Though many closure strategies have been applied, including endoclips, kissing sutures, and over-the-scope clip systems, it is still time-consuming and skill-dependent [3]. Here, we present a large full-thickness defect following EFTR that healed successfully without closure due to coverage by the connective tissue.
A 19-year-old woman had an elevated giant lesion 54 mm in diameter at the antrum of the stomach ([Fig. 1], [Fig. 2]). After acquiring informed consent, a standard EFTR was performed ([Video 1]). Originally, a nylon ligature in combination with clips was chosen to close the defect. The scheduled defect closure was extremely difficult to accomplish because the arms of the available clips could not bring both edges of the defect into alignment for closure. Despite the full-thickness resection performed, we noticed that the base was completely covered by the connective tissue and the great omentum, which still maintained the integrity of the gastric body ([Fig. 3]). Subsequently, the decision to keep the defect open with the help of nasogastric decompression was made after obtaining additional informed consent. Follow-up endoscopy on postoperative day 3 revealed the base of the defect was strong enough by touching with forceps, and therefore the nasogastric tube was withdrawn ([Fig. 4]). The patient resumed a liquid diet on postoperative day 4 and was discharged without experiencing any adverse events. Endoscopy at the 2-month follow-up revealed the satisfactory closure of the wall defect ([Fig. 5]).
Quality:
Our experience indicates that non-closure is sometimes an applicable choice under nasogastric decompression and close postoperative observation only if the defect is non-leaking. However, future data are definitely required to evaluate the safety and efficacy of non-closure.
Endoscopy_UCTN_Code_TTT_1AO_2AI
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Publication History
Article published online:
25 September 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Li-Ping Y, Zhang Y, Xin-Li M. et al. Endoscopic full-thickness resection with defect closure using clips and an endoloop for gastric subepithelial tumors arising from the muscularis propria. Surg Endosc 2014; 28: 1978-1983
- 2 Yorimasa Y, Daisuke K, Yasuaki N. et al. Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts. Dig Endosc 2019; 31: 4-20
- 3 Hirohito M, Hideki K, Noriko N. et al. Current status and future perspectives of endoscopic full-thickness resection. Dig Endosc 2018; 30: 25-31