Closure of Mucosal Defects Using Endoscopic Suturing Following Endoscopic Submucosal Dissection: A Single-Center Experience

Abstract

Background and Aims

Endoscopic submucosal dissection (ESD) is a therapeutic technique for en-bloc resection of both large (>20 mm) and smaller, complex gastrointestinal neoplasms. ESD has a higher success rate of en-bloc resection and a lower rate of local recurrence compared with endoscopic mucosal resection. Removal of lesions via ESD can leave large mucosal defects, raising unique challenges leading to adverse events. We aimed to determine clinical outcomes, including delayed bleeding, perforation, and hospitalization, in patients undergoing endoscopic suturing after ESD.

Methods

This was a single-center retrospective study of a prospectively collected database of consecutive adult patients who underwent ESD with mucosal defect closure using endoscopic suturing. Primary outcomes were adverse events, specifically delayed bleeding or perforation. Secondary outcomes included need for hospitalization and suturing complications.

Results

Fifty-five patients (mean age: 67 years) were included, with a mean lesion size of 27.4 ± 15 mm. Defect closure occurred in the esophagus (6), gastroesophageal junction (2), stomach (30), cecum (2), sigmoid colon (2), and rectum (13). A mean of 1.8 ± 1.0 sutures were required for defect closure. The hospital admission rates was 14% (8/55), with an average length of stay 2 days (range 1-3 days). Intraprocedural perforation occurred in 2 patients, and both were successfully treated with endoscopic suturing. There was one case of delayed bleeding and no cases of delayed perforation or suturing complications.

Conclusion

The use of endoscopic suturing following ESD is a safe and clinically reliable method to close mucosal defects. This approach is associated with minimal adverse events and need for hospitalization. Larger studies are needed to further validate these findings.