Is closure of large mucosal defects after endoscopic mucosal resection and endoscopic submucosal dissection truly needed?

Abstract

We read with interest the article by Sakamoto et al. [1] on closure of large mucosal defects after endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for the prevention of complications. Because closure of large mucosal defects is quite difficult with conventional clips, they designed a new closure device, a “loop clip”, which consists of a metal clip attached to a loop of nylon string. After a loop clip was connected to the mid edges of a large mucosal defect, conventional clips were placed to achieve complete closure in three lesions. With a figure-of-8-shaped ring (8-ring) and clips [2], and with an endoloop and clips [3], other endoscopic closure techniques for post-EMR large mucosal defects were also described. We believe that these techniques have some drawbacks, and furthermore, we doubt whether the prophylactic closure could effectively prevent delayed bleeding.