Low delayed bleeding and high complete closure rate of mucosal defects with the novel through-the-scope dual-action tissue clip after endoscopic resection of large nonpedunculated colorectal lesions (with video)

Abstract

Background and AimsComplete closure following endoscopic resection (ER) of large non-pedunculated colorectal lesions (LNPCLs) can reduce delayed bleeding but is challenging with conventional through-the-scope (TTS) clips alone. The novel dual action tissue (DAT) has clip arms that open and close independent of each other, facilitating tissue approximation. We aimed to evaluate the rate of complete closure and delayed bleeding with the DAT clip after ER of LNPCLs. MethodsMulticenter prospective cohort study of all patients who underwent defect closure with the DAT clip following endoscopic mucosal resection (EMR) or submucosal dissection (ESD) of LNPCLs ≥ 20 mm from July 2022 to May 2023. Delayed bleeding was defined as bleeding event requiring hospitalization, blood transfusion or any intervention within 30 days after the procedure. Complete closure was defined as apposition of mucosal defect margins without visible submucosal areas < 3 mm along the closure line. ResultsA total of 107 patients (median age 64 years; 42.5% women) underwent EMR (n=63) or ESD (n=44) of LNPCLs (median size 40 mm; 74.8% right colon) followed by defect closure. Complete closure was achieved in 96.3% (n=103) with a mean of 1.4±0.6 DAT and 2.9±1.8 TTS clips. Delayed bleeding occurred in one patient (0.9%) without requiring additional interventions. ConclusionThe use of the DAT clip in conjunction with TTS clips achieved high complete defect closure after ER of large LNPCLs and was associated with a 0.9% delayed bleeding rate. Future comparative trials and formal cost-analyses are needed to validate these findings.