ASGE Advanced Endoscopic Lesion Resection Course | November 2022-12 Ngamruengphong

12 Ngamruengphong_How and when to close the defect

Pdf Summary

This document discusses various techniques and devices for closing defects after polypectomy or perforation in gastrointestinal procedures. The text references several studies and provides an overview of different closure methods and their effectiveness.<br /><br />The document begins by disclosing the author's consultant roles for certain medical companies. It then discusses the importance of inspecting the base after polypectomy or endoscopic mucosal resection (EMR) procedures in order to assess any residual adenoma, visible vessels, or muscle injury. Data on closure techniques for EMR and EMR with submucosal dissection (ESD) are also reviewed.<br /><br />The Sydney classification system for deep mural injury following colorectal EMR is presented, which categorizes different types of injuries based on mucosal and submucosal involvement. Closure recommendations are provided for each type of injury, with clip closure being recommended for certain cases to prevent delayed perforation.<br /><br />The document further explores different closure devices and techniques, such as through-the-scope clip closure, endoscopic suturing devices (including OverStitch), and string clip suturing methods. Studies and meta-analyses evaluating the effectiveness of clip closure and prophylactic closure after EMR or ESD procedures are referenced.<br /><br />The use of the MANTIS clip, a dual-action clip with anchor prongs, is discussed, as well as the technique of "hold-and-drag" closure. The document also mentions the X-Tack endoscopic helix tacking system and through-the-scope suturing (TTSS) methods.<br /><br />Overall, the document provides an overview of various closure techniques and devices and highlights their potential benefits for effective defect closure after gastrointestinal procedures.

Keywords

closing defects

polypectomy

perforation

closure methods

EMR

Sydney classification system

clip closure

endoscopic suturing devices

MANTIS clip

defect closure