Affiliation:
1. Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan
2. Digestive Diseases Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
Abstract
Abstract
Background and study aims Mucosal defect closure after colorectal
endoscopic submucosal dissection (ESD) has the potential to reduce the occurrence of delayed
adverse events (AEs) such as bleeding and perforation. This study aimed to assess the
feasibility and effectiveness of the Loop9 method for closing mucosal defects following
colorectal ESD.
Patients and methods A retrospective single-center study was
conducted using prospectively collected data from May 2020 to March 2023. Loop9 was deployed
through a single instrument channel and anchored with clips at the defect site. Closure was
accomplished by tightening the loop and deploying additional conventional clips as needed for
complete closure. The primary outcome was complete closure rate, with secondary outcomes
including the sustained closure rate at 4 to 5 days post-ESD, closed defect size, closure
time, number of additional clips, and incidence of delayed AEs.
Results This study included 118 cases. Complete closure was
achieved in 96.6% of cases (114/118) with a sustained closure rate of 93.9% (107/114). The
median size of the closed mucosal defects was 30 mm (interquartile range [IQR]: 25–38, range:
15–74). The median closure time was 14 minutes (IQR: 11.25–17), and the median number of
additional clips deployed was six (IQR: 4–7). Stenosis requiring balloon dilatation was
observed in one patient; however, there were no instances of post-ESD bleeding or delayed
perforation.
Conclusions The Loop9 method proved feasible and effective for
closing mucosal defects following colorectal ESD, achieving high rates of complete and
sustained closure.