ASGE Advanced Endoscopic Lesion Resection Course (On-Demand) | November 2022-12 Ngamruengphong

12 Ngamruengphong_How and when to close the defect

Pdf Summary

The document discusses various techniques and methods for closing defects after polypectomy or perforation during endoscopic procedures. It mentions the importance of inspecting the base after polypectomy to check for residual adenoma, visible vessels, and muscle injury. Closure techniques discussed include clips, sutures, rubber bands, and other devices.<br /><br />The document also reviews data on closure after endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). The use of prophylactic coagulation to non-bleeding vessels in the resection area after ESD is shown to reduce bleeding rates. The Sydney classification is used to categorize different types of deep mural injuries following colorectal EMR, with recommendations for clip closure to prevent delayed perforation.<br /><br />The document mentions the challenges in defect closure using endoclips, and alternative devices such as OverStitch and through-the-scope suturing. Studies show the efficacy of clip closure for preventing bleeding after EMR of large polyps in the proximal colon. Prophylactic clipping is also found to be effective in reducing delayed bleeding in proximal polyps ≥20 mm, especially in patients on antithrombotic medications.<br /><br />Other closure techniques discussed include the "hold-and-drag" technique, clips with anchor prongs, string clip suturing, and the use of endoscopic suturing devices like OverStitch and through-the-scope suturing. The document provides insights into the success rates, procedure times, and potential adverse events associated with these closure techniques.<br /><br />Overall, the document provides a comprehensive overview of available techniques and data on closing defects after polypectomy or perforation, highlighting different closure methods and their efficacy in preventing complications such as bleeding and delayed perforation.

Keywords

defect closure

polypectomy

perforation

endoscopic procedures

base inspection

closure techniques

clips

sutures

rubber bands

prophylactic coagulation