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Closure with clips to accelerate healing of mucosal defects caused by colorectal endoscopic submucosal dissection

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Abstract

Background

Most mucosal defects that occur with endoscopic submucosal dissection (ESD) can be closed completely using endoscopic clips. However, benefits of such closure in wound healing are unknown. A randomized controlled study evaluated the efficacy of closure with clips compared with no closure.

Method

Twenty-eight patients who had undergone ESD were randomly divided into two groups: closure (n = 14) and non-closure groups (n = 14). In the closure group, the mucosal defect resulting from ESD was closed using endoscopic clips. Four weeks after ESD, defects in both groups were observed by colonoscopy. Efficacy was based on change in the area of the defect, percentage of complete healing in each group, and complications.

Result

Data were analyzed for 26 of the 28 patients (13, closure group; 13, non-closure group). All tumors were resected en bloc by ESD without bleeding or perforation. In the closure group, the area of the defect just after ESD was 677 ± 306 mm2 (mean ± SD) as determined by the size of the removed lesion and had decreased to 2.17 ± 4.51 mm2 at 4 weeks after ESD (reduction, 99.7 %), but in the non-closure group that area was 790 ± 221 mm2 and had decreased to 27.42 ± 25.72 mm2 at 4 weeks post-ESD (reduction, 96.2 %). The reduction rate was significantly higher in the closure than in the non-closure group (99.7 vs. 96.2 %, p = 0.010). Complete healing was 69.2 % in the closure group vs. 7.7 % in the non-closure group (p = 0.005). Multivariate analysis showed that closure of the mucosal defect (OR 24.029, 95 % CI 2.09–276.15, p = 0.011) was an independent factor associated with complete healing at 4 weeks after ESD. Delayed perforation or post-ESD bleeding was not observed in any participant.

Conclusion

Use of endoscopic clips for closure of defects after ESD is safe and efficacious in accelerating wound healing.

Trial registration

UMIN-CTR UMIN000009112

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Acknowledgments

This work was supported in part by Grant-in-Aid for Scientific Research (C) (No. 23591023) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.

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Authors and Affiliations

  1. Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Taro Osada, Naoto Sakamoto, Hideaki Ritsuno, Takashi Murakami, Hiroya Ueyama, Kenshi Matsumoto, Tomoyoshi Shibuya, Tatsuo Ogihara & Sumio Watanabe

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  1. Taro Osada
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  2. Naoto Sakamoto
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  3. Hideaki Ritsuno
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Correspondence to Taro Osada.

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Taro Osada, Naoto Sakamoto, Hideaki Ritsuno, Takashi Murakami, Hiroya Ueyama, Kenshi Matsumoto, Tomoyoshi Shibuya, Tatsuo Ogihara, and Sumio Watanabe have no conflicts of interest or financial ties to disclose.

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Osada, T., Sakamoto, N., Ritsuno, H. et al. Closure with clips to accelerate healing of mucosal defects caused by colorectal endoscopic submucosal dissection. Surg Endosc 30, 4438–4444 (2016). https://doi.org/10.1007/s00464-016-4763-7

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