Novel Through-the-Scope Suture Closure of Colonic Endoscopic Mucosal Resection Defects.

BACKGROUND AND AIMS: Large colon polyps removed by endoscopic mucosal resection (EMR) can be complicated by delayed bleeding. Prophylactic defect clip closure can reduce post-EMR bleeding. Larger defects can be challenging to close using through-the-scope clips (TTSCs) and proximal defects are difficult to reach using over-the-scope techniques. A novel, through-the-scope suture (TTSS) device allows direct closure of mucosal defects without scope withdrawal. We aim to evaluate the rate of delayed bleeding following the closure of large colon polyp EMR sites with TTSS.

METHODS: A multi-center retrospective cohort study was performed involving 13 centers. All defect closure by TTSS following EMR of colon polyps ≥2 cm from January 2021 to February 2022 were included. The primary outcome was rate of delayed bleeding.

RESULTS: A total of 94 patients (F= 52%, mean age 65 years) underwent EMR of predominantly right sided (n=62, 66%) colon polyps (median size 35 mm, IQR 30-40) followed by defect closure with TTSS during the study period. All defects were successfully closed with TTSS alone (n=62, 66%) or with TTSS and TTSC (n=32, 34%), using a median of 1 (IQR 1-1) TTSS systems. Delayed bleeding occurred in three patients (3.2%) with two requiring repeat endoscopic evaluation/treatment (moderate).

CONCLUSION: TTSS alone or with TTSC was effective in achieving complete closure of all post-EMR defects, despite a large lesion size. Following TTSS closure with or without adjunctive devices, delayed bleeding was seen in 3.2% of cases. Further prospective studies are needed to validate these findings before wider adoption of TTSS for large polypectomy closure.