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Prophylactic clipping using the over-the-scope clip (OTSC) system after complex ESD and EMR of large colon polyps

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Abstract

Background

Delayed bleeding is the most frequent complication after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) of large colon polyps. Today, prophylactic clipping with through-the-scope clips (TTSCs) is commonly used to reduce the risk of bleeding. However, the over-the-scope clip (OTSC) system might be superior to TTSCs in achieving hemostasis. This study aims to evaluate the efficacy and safety of prophylactic clipping using the OTSC system after ESD or EMR of large colon polyps.

Methods

This is a retrospective analysis of a prospective collected database from 2009 until 2021 of three endoscopic centers. Patients with large (≥ 20 mm) colon polyps were enrolled. All polyps were removed by either ESD or EMR. After the resection, OTSCs were prophylactically applied on parts of the mucosal defect with a high risk of delayed bleeding or/and perforation. The main outcome measurement was delayed bleeding.

Results

A total of 75 patients underwent ESD (67%, 50/75) or EMR (33%, 25/75) in the colorectum. The mean resected specimen diameter was 57 mm ± 24.1 (range 22–98 mm). The mean number of OTSCs placed on the mucosal defect was 2 (range 1–5). None of the mucosal defects were completely closed. Intraprocedural bleeding occurred in 5.3% (ESD 2.0% vs. EMR 12.0%; P = 0.105), and intraprocedural perforation occurred in 6.7% (ESD 8% vs. EMR 4%; P = 0.659) of the patients. Hemostasis was achieved in 100% of cases of intraprocedural bleeding, whereas two patients required surgical conversion due to intraprocedural perforation. Among the remaining 73 patients who received prosphylactic clipping, delayed bleeding occurred in 1.4% (ESD 0% vs. EMR 4.2%; P = 0.329), and delayed perforation occurred in 0%.

Conclusions

The prophylactic partial closure of large post-ESD/EMR mucosal defects using OTSCs could serve as an effective strategy to reduce the risk of delayed bleeding and perforation.

Graphical abstract

The prophylactic partial closure of large complex post-ESD/EMR mucosal defects using OTSCs could serve as an effective strategy to reduce the risk of delayed bleeding and perforation.

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  1. J. Hochberger and E. Wedi shared last author.

Authors and Affiliations

  1. Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Starkenburgring 66, 63069, Offenbach, Germany

    T. Blasberg, M. Meiborg, M. Weber & E. Wedi

  2. Department of Gastroenterology, Vivantes Hospital Friedrichshain Berlin, Berlin, Germany

    J. Hochberger & T. Brunk

  3. Department of Internal Medicine III, St. Bernward Hospital, Hildesheim, Germany

    L. Leifeld

  4. Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany

    A. Seif Amir Hosseini

  5. Clinic for Gastroenterology, Gastrointestinal Oncology and Endocrinology, University of Göttingen, Göttingen, Germany

    C. Jung & E. Wedi

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J. Hochberger reports honoraria for lectures (Ovesco, Falk Foundation, Fujifilm) and research support on behalf of Ovesco Corp. Tuebingen, Germany. E. Wedi reports honoraria for lectures and research support on behalf of Ovesco Corp. Tuebingen, Germany. T. Blasberg, M. Meiborg, C. Jung, M. Weber, T. Brunk, L. Leifeld, and A. Seif Amir Hosseini have no conflicts of interest or financial ties to disclose.

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Blasberg, T., Hochberger, J., Meiborg, M. et al. Prophylactic clipping using the over-the-scope clip (OTSC) system after complex ESD and EMR of large colon polyps. Surg Endosc 37, 7520–7529 (2023). https://doi.org/10.1007/s00464-023-10235-2

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