Sa2003 CLOSURE OF ENDOSCOPIC SUBMUCOSAL DISSECTION DEFECTS WITH ENDOSCOPIC SUTURING TO PREVENT ADVERSE EVENTS

Abstract

Endoscopic submucosal dissection (ESD) enables en bloc removal of gastrointestinal epithelial lesions but can leave behind a large defect. These defects can result in adverse events such as delayed bleeding, delayed perforation, abdominal pain, or fever. Monitoring for these adverse events may necessitate observation in the hospital for several days. While prophylactic defect closure with clips has been well-described, there are little data regarding the use of endoscopic suturing to close these defects. The aim of this study therefore was to examine the safety and efficacy of endoscopic suturing in closing ESD defects to prevent adverse events and potentially avoid post-procedure hospitalization. In this single-center prospective study, endoscopic suturing was performed to close ESD defects after ESD in the stomach or rectum. Suturing was performed in the antegrade position starting from the edge most distal to the scope insertion site (12 o’clock position), moving from left (10 o’clock position) to right (2 o’clock position), right to left (8 o’clock position), left to right (4 o’clock position) before ending at the edge most proximal (6 o’clock position) to the scope insertion site (Figure). Surveillance endoscopies were performed to evaluate for recurrence/residual tissue and healing of the resection scar. Summary statistics were used to describe patient, lesion, and procedure characteristics as well as adverse event outcomes. In total, 31 patients (mean age 65.6, 71% male) received endoscopic suturing after gastric (58.1%) or rectal (41.9%) ESD (Table). The most common lesion pathology was adenocarcinoma (22.6%) followed by adenomas with high-grade dysplasia (19.4%) and low-grade dysplasia (19.4%). The mean dissection time was 54.8 minutes and the mean suturing time was 13.4 minutes. Significant intraprocedural bleeding occurred in 2 (6.5%) cases with no instances of intraprocedural perforation. Same-day discharge occurred in 58.1% of patients with a mean length of stay of 1 day in those who required overnight admission. There were no instances of delayed bleeding or delayed perforation. Surveillance endoscopy was performed at a mean of 143.9 days with no recurrences or residual tissue found. In this prospective study, endoscopic suturing offered a safe and efficacious method of closing ESD defects after gastric and rectal ESD without significantly prolonging procedure time. There were no instances of delayed bleeding or delayed perforation and over half of the patients were able to be discharged the same day. Larger, randomized studies will be needed to compare endoscopic suturing with other techniques of defect closure and evaluate its cost-effectiveness.TablePatient, lesion, and procedure characteristics and patient outcomesView Large Image Figure ViewerDownload Hi-res image Download (PPT)