Line-assisted complete closure for a large mucosal defect after colorectal endoscopic submucosal dissection decreased post-electrocoagulation syndrome

Yasushi Yamasaki, Yoji Takeuchi, Taro Iwatsubo, Minoru Kato, Kenta Hamada, Yusuke Tonai, Noriko Matsuura, Takashi Kanesaka, Takeshi Yamashina, Masamichi Arao, Sho Suzuki, Satoki Shichijo, Hiroko Nakahira, Tomofumi Akasaka, Noboru Hanaoka, Koji Higashino, Noriya Uedo, Ryu Ishihara, Hiroyuki Okada, Hiroyasu Iishi

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background and Aim: The incidence of post-endoscopic submucosal dissection (ESD) coagulation syndrome (PECS) can be decreased by closing mucosal defects. However, large mucosal defects after colorectal ESD cannot be closed endoscopically. We established line-assisted complete clip closure (LACC), a novel technique for large mucosal defects after colorectal ESD. We evaluated the prophylactic efficacy of LACC for preventing PECS. Methods: Sixty-one consecutive patients on whom LACC after colorectal ESD was attempted from January 2016 to August 2016 were analyzed. After exclusion of patients with incomplete LACC and adverse events during ESD, 57 patients comprised the LACC group. In contrast, 495 patients who did not undergo closure of a mucosal defect comprised the control group. Propensity score matching was used to adjust for patients' backgrounds. Treatment outcomes were evaluated between the groups. Results: Median resected specimen size in the LACC-attempted group was 35 mm (range, 20-72 mm), and LACC success rate was 95% (58/61). Median procedure time of LACC was 14 min. In the LACC group, incidence of PECS was only 2%, and no delayed bleeding or perforation occurred. Propensity score matching created 51 matched pairs. Adjusted comparisons between the LACC and control groups showed a lower incidence of PECS (0% vs 12%, respectively; P = 0.03) and shorter hospitalization (5 vs 6 days, respectively; P < 0.001) in the LACC group. Conclusion: This study suggests that LACC can effectively reduce the incidence of PECS, although further large-scale studies are warranted.

Original languageEnglish
JournalDigestive Endoscopy
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Electrocoagulation
Surgical Instruments
Propensity Score
Incidence
Endoscopic Mucosal Resection
Control Groups
Hospitalization

Keywords

  • Clip closure
  • Colorectal endoscopic submucosal dissection
  • Colorectal neoplasm
  • Post-electrocoagulation syndrome
  • Propensity score matching

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Line-assisted complete closure for a large mucosal defect after colorectal endoscopic submucosal dissection decreased post-electrocoagulation syndrome. / Yamasaki, Yasushi; Takeuchi, Yoji; Iwatsubo, Taro; Kato, Minoru; Hamada, Kenta; Tonai, Yusuke; Matsuura, Noriko; Kanesaka, Takashi; Yamashina, Takeshi; Arao, Masamichi; Suzuki, Sho; Shichijo, Satoki; Nakahira, Hiroko; Akasaka, Tomofumi; Hanaoka, Noboru; Higashino, Koji; Uedo, Noriya; Ishihara, Ryu; Okada, Hiroyuki; Iishi, Hiroyasu.

In: Digestive Endoscopy, 01.01.2018.

Research output: Contribution to journalArticle

Yamasaki, Y, Takeuchi, Y, Iwatsubo, T, Kato, M, Hamada, K, Tonai, Y, Matsuura, N, Kanesaka, T, Yamashina, T, Arao, M, Suzuki, S, Shichijo, S, Nakahira, H, Akasaka, T, Hanaoka, N, Higashino, K, Uedo, N, Ishihara, R, Okada, H & Iishi, H 2018, 'Line-assisted complete closure for a large mucosal defect after colorectal endoscopic submucosal dissection decreased post-electrocoagulation syndrome', Digestive Endoscopy. https://doi.org/10.1111/den.13052
Yamasaki, Yasushi ; Takeuchi, Yoji ; Iwatsubo, Taro ; Kato, Minoru ; Hamada, Kenta ; Tonai, Yusuke ; Matsuura, Noriko ; Kanesaka, Takashi ; Yamashina, Takeshi ; Arao, Masamichi ; Suzuki, Sho ; Shichijo, Satoki ; Nakahira, Hiroko ; Akasaka, Tomofumi ; Hanaoka, Noboru ; Higashino, Koji ; Uedo, Noriya ; Ishihara, Ryu ; Okada, Hiroyuki ; Iishi, Hiroyasu. / Line-assisted complete closure for a large mucosal defect after colorectal endoscopic submucosal dissection decreased post-electrocoagulation syndrome. In: Digestive Endoscopy. 2018.
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abstract = "Background and Aim: The incidence of post-endoscopic submucosal dissection (ESD) coagulation syndrome (PECS) can be decreased by closing mucosal defects. However, large mucosal defects after colorectal ESD cannot be closed endoscopically. We established line-assisted complete clip closure (LACC), a novel technique for large mucosal defects after colorectal ESD. We evaluated the prophylactic efficacy of LACC for preventing PECS. Methods: Sixty-one consecutive patients on whom LACC after colorectal ESD was attempted from January 2016 to August 2016 were analyzed. After exclusion of patients with incomplete LACC and adverse events during ESD, 57 patients comprised the LACC group. In contrast, 495 patients who did not undergo closure of a mucosal defect comprised the control group. Propensity score matching was used to adjust for patients' backgrounds. Treatment outcomes were evaluated between the groups. Results: Median resected specimen size in the LACC-attempted group was 35 mm (range, 20-72 mm), and LACC success rate was 95{\%} (58/61). Median procedure time of LACC was 14 min. In the LACC group, incidence of PECS was only 2{\%}, and no delayed bleeding or perforation occurred. Propensity score matching created 51 matched pairs. Adjusted comparisons between the LACC and control groups showed a lower incidence of PECS (0{\%} vs 12{\%}, respectively; P = 0.03) and shorter hospitalization (5 vs 6 days, respectively; P < 0.001) in the LACC group. Conclusion: This study suggests that LACC can effectively reduce the incidence of PECS, although further large-scale studies are warranted.",
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T1 - Line-assisted complete closure for a large mucosal defect after colorectal endoscopic submucosal dissection decreased post-electrocoagulation syndrome

AU - Yamasaki, Yasushi

AU - Takeuchi, Yoji

AU - Iwatsubo, Taro

AU - Kato, Minoru

AU - Hamada, Kenta

AU - Tonai, Yusuke

AU - Matsuura, Noriko

AU - Kanesaka, Takashi

AU - Yamashina, Takeshi

AU - Arao, Masamichi

AU - Suzuki, Sho

AU - Shichijo, Satoki

AU - Nakahira, Hiroko

AU - Akasaka, Tomofumi

AU - Hanaoka, Noboru

AU - Higashino, Koji

AU - Uedo, Noriya

AU - Ishihara, Ryu

AU - Okada, Hiroyuki

AU - Iishi, Hiroyasu

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background and Aim: The incidence of post-endoscopic submucosal dissection (ESD) coagulation syndrome (PECS) can be decreased by closing mucosal defects. However, large mucosal defects after colorectal ESD cannot be closed endoscopically. We established line-assisted complete clip closure (LACC), a novel technique for large mucosal defects after colorectal ESD. We evaluated the prophylactic efficacy of LACC for preventing PECS. Methods: Sixty-one consecutive patients on whom LACC after colorectal ESD was attempted from January 2016 to August 2016 were analyzed. After exclusion of patients with incomplete LACC and adverse events during ESD, 57 patients comprised the LACC group. In contrast, 495 patients who did not undergo closure of a mucosal defect comprised the control group. Propensity score matching was used to adjust for patients' backgrounds. Treatment outcomes were evaluated between the groups. Results: Median resected specimen size in the LACC-attempted group was 35 mm (range, 20-72 mm), and LACC success rate was 95% (58/61). Median procedure time of LACC was 14 min. In the LACC group, incidence of PECS was only 2%, and no delayed bleeding or perforation occurred. Propensity score matching created 51 matched pairs. Adjusted comparisons between the LACC and control groups showed a lower incidence of PECS (0% vs 12%, respectively; P = 0.03) and shorter hospitalization (5 vs 6 days, respectively; P < 0.001) in the LACC group. Conclusion: This study suggests that LACC can effectively reduce the incidence of PECS, although further large-scale studies are warranted.

AB - Background and Aim: The incidence of post-endoscopic submucosal dissection (ESD) coagulation syndrome (PECS) can be decreased by closing mucosal defects. However, large mucosal defects after colorectal ESD cannot be closed endoscopically. We established line-assisted complete clip closure (LACC), a novel technique for large mucosal defects after colorectal ESD. We evaluated the prophylactic efficacy of LACC for preventing PECS. Methods: Sixty-one consecutive patients on whom LACC after colorectal ESD was attempted from January 2016 to August 2016 were analyzed. After exclusion of patients with incomplete LACC and adverse events during ESD, 57 patients comprised the LACC group. In contrast, 495 patients who did not undergo closure of a mucosal defect comprised the control group. Propensity score matching was used to adjust for patients' backgrounds. Treatment outcomes were evaluated between the groups. Results: Median resected specimen size in the LACC-attempted group was 35 mm (range, 20-72 mm), and LACC success rate was 95% (58/61). Median procedure time of LACC was 14 min. In the LACC group, incidence of PECS was only 2%, and no delayed bleeding or perforation occurred. Propensity score matching created 51 matched pairs. Adjusted comparisons between the LACC and control groups showed a lower incidence of PECS (0% vs 12%, respectively; P = 0.03) and shorter hospitalization (5 vs 6 days, respectively; P < 0.001) in the LACC group. Conclusion: This study suggests that LACC can effectively reduce the incidence of PECS, although further large-scale studies are warranted.

KW - Clip closure

KW - Colorectal endoscopic submucosal dissection

KW - Colorectal neoplasm

KW - Post-electrocoagulation syndrome

KW - Propensity score matching

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