Comparative Safety of Mucomuscular vs Traditional Clip Closure in Colorectal ESD

Overview

This prospective cohort study of 764 patients demonstrated that mucomuscular closure significantly reduces the incidence of post-endoscopic submucosal dissection electrocoagulation syndrome (PEECS) compared to conventional clip closure (2.5% vs 15.0%). Additionally, mucomuscular closure was associated with no severe adverse events, unlike the conventional method which had cases of delayed perforation and bleeding.

Background

Post-endoscopic submucosal dissection electrocoagulation syndrome (PEECS) is a notable complication of colorectal ESD, leading to increased morbidity and healthcare costs. Reliable closure of mucosal defects after ESD is critical to prevent PEECS. Traditional closure techniques use through-the-scope clips (TTSC) applied to the mucosal layer, but a novel mucomuscular closure technique directly approximates the muscularis propria using TTSC. This study evaluates the safety and efficacy of this modified closure method in a large cohort.

Data Highlights

Key Findings

• Mucomuscular closure significantly lowers PEECS incidence compared to conventional clip closure (2.5% vs 15.0%, P < 0.001).
• No severe adverse events occurred in the mucomuscular closure group, while the conventional group had delayed perforations and bleeding.
• PEECS rates were similar between complete and partial mucomuscular closure, indicating partial closure still confers protection.
• No perforations related to TTSC occurred during defect closure in the mucomuscular group.
• The mucomuscular technique is feasible and safe for closing large colorectal ESD defects exceeding 15 mm.

Clinical Implications

Mucomuscular closure using through-the-scope clips should be considered a preferred method for defect closure after colorectal ESD to reduce PEECS and severe complications. Even partial closure with this technique provides significant protection, potentially simplifying the procedure. Adoption of this method may improve patient outcomes and reduce hospital stays and costs associated with post-ESD complications.

Conclusion

Mucomuscular closure is a safe and effective technique that significantly decreases the incidence of PEECS and severe adverse events following colorectal ESD for large nonpedunculated polyps. This method represents an advancement in post-ESD defect management.

References

1. Wang J et al. 2014 -- Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors: a meta-analysis
2. Lee H et al. 2012 -- Clinical features and predictive factors of coagulation syndrome after endoscopic submucosal dissection for early gastric neoplasm
3. Jung D et al. 2013 -- Risk of electrocoagulation syndrome after endoscopic submucosal dissection in the colon and rectum
4. Yamasaki Y et al. 2018 -- Line-assisted complete closure for a large mucosal defect after colorectal endoscopic submucosal dissection decreased post-electrocoagulation syndrome
5. Masunaga T et al. 2023 -- Modified double-layered suturing for a mucosal defect after colorectal endoscopic submucosal dissection (Origami method)