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Endoscopic Closure Utilizing Endoloop and Endoclips After Gastric Endoscopic Submucosal Dissection for Patients on Antithrombotic Therapy

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Abstract

Objectives

Antithrombotic therapy is a well-known independent risk factor for bleeding after endoscopic submucosal dissection (ESD) of early gastric cancer (EGC). A novel method of ulcer base closure using an endoloop and endoclips has been reported. This study aimed to evaluate the effectiveness of endoscopic closure using an endoloop and endoclips in preventing post-ESD bleeding in patients undergoing gastric ESD on antithrombotic therapy.

Methods

This was a single center, retrospective study. Patients on antithrombotic therapy who underwent gastric ESD were divided into two groups, the closure group and the non-closure group. We analyzed procedural outcomes, post-ESD bleeding rate and factors associated with post-ESD bleeding.

Results

Among 400 ESDs with EGCs in 311 patients, 131 ESDs in 110 patients were in the closure group, and 269 ESDs in 217 patients were in the non-closure group (16 patients were overlapped in both groups). Post-ESD bleeding rate was 11.5% (15/131) in the closure group, and 11.9% (32/269) in the non-closure group (p = 0.89). Total sustained closure rate during second look endoscopy was 47.8% (33/69). Post-ESD bleeding rate tended to be lower in the closure group than in the non-closure group for lesions located in the greater curvature (3.6% vs. 11.1%, p = 0.11). In addition, sustained closure rate was significantly higher in the greater curvature than in the lesser curvature (72.0% vs. 34.1%, p < 0.01). Multivariate analysis revealed resection size > 40 mm and heparin bridge were the independent risk factor for post-ESD bleeding.

Conclusion

Ulcer base closure using endoloop and endoclips did not prevent post-ESD bleeding in patients on antithrombotic therapy.

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Acknowledgments

We would like to thank Dr. Lady Katherine, Mejía Pérez (Internal Medicine, Cleveland Clinic Foundation) for her kind support of this article. In addition, part of this work was supported by the National Cancer Center Research and Development Fund (25-A-12, 28-K-1, and 29-A-12).

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Authors and Affiliations

  1. Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Mai Ego, Seiichiro Abe, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Ichiro Oda & Yutaka Saito

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  1. Mai Ego
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  2. Seiichiro Abe
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  3. Satoru Nonaka
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  4. Haruhisa Suzuki
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  7. Yutaka Saito
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Correspondence to Seiichiro Abe.

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Supplementary material 1 (DOCX 21 kb)

ESD was performed for the lesion located at the lesser curvature of the fornix. A double-channel gastroscope was introduced. An endoloop was opened through the first channel, and an endoclip was inserted through the other channel. The endoloop was placed along the edge of the mucosal defect anchored by endoclips. The mucosal defect was successfully closed by tightening the fixed endoloop. Finally, the endoclips were attached to the endoloop to keep it closed (MOV 44353 kb)

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Ego, M., Abe, S., Nonaka, S. et al. Endoscopic Closure Utilizing Endoloop and Endoclips After Gastric Endoscopic Submucosal Dissection for Patients on Antithrombotic Therapy. Dig Dis Sci 66, 2336–2344 (2021). https://doi.org/10.1007/s10620-020-06508-8

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  • DOI: https://doi.org/10.1007/s10620-020-06508-8

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