Therapeutic and Prophylactic Closure Post-Endoscopic Submucosal Dissection (ESD): A Unicentric Descriptive Analysis

Aims Intraprocedural perforation is the most common complication of endoscopic submucosal dissection (ESD), with a prevalence of 6-12% in Western series. Most cases can be endoscopically resolved using clips for closure. Prophylactic closure may reduce the rate of post-ESD complications, particularly delayed bleeding, although it incurs additional costs. The aims of this study were to conduct a descriptive analysis of endoscopic closures post-ESD and estimate the number of clips required.

Methods Data analysis from a prospective registry that includes all ESDs performed at a center between June 2023 and June 2024, where some form of endoscopic closure was applied. The relationship between the number of clips used and the size of the dissected area was analyzed.

Results Out of 141 ESDs performed during this period, 85 (60.3%) involved some form of closure. 62.4% of the patients were male, with a mean age of 68.9 years. The distribution of lesions by location was as follows: stomach 9.4%, proximal colon 44.7%, distal colon 40%, and rectum 5.9%. The mean size of the lesion was 43.8 mm, and the mean dissected area was 33.3 cm². Technical success was achieved in 100% of the endoscopic submucosal dissections (ESD) performed. There were 22 intraprocedural perforations (15.6%), all successfully closed endoscopically. A total of 63 prophylactic closures were performed (55.5%, with 19 partial and 44 complete). One patient experienced delayed perforation despite complete prophylactic closure, necessitating urgent surgery. No other delayed complications were recorded [1] [2] [3]. An average of 13.6 clips were used per closure, and in 23 cases, some auxiliary technique was employed. A statistically significant relationship was found between the dissected area and the number of clips used (p=0.006), with one clip required for every 1.4 cm² of dissected area.

Conclusions Endoscopic closure is common following ESD, regardless of the intraprocedural perforation rate. The dissected surface area may allow for the estimation of the number of clips required per closure, anticipating an increase in costs and time.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

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