Single-Center Experience Of Managment Of Perforation After Endoscopical Submucosal Dissection (Esd) Using Over-The-Scope Clip

Aims BACKGROUND AND AIMS: The Endoscopical Submucosal Dissection (ESD) is an advanced resection technique for removing “en bloc” gastrointestinal (GI) lesions, bigger than 20 mm and with macroscopic features of no deep infiltration (limited to the submucosal). It is a complex procedure and, therefore, with risk of complications (early and/or delayed), first of all bleeding, then perforation. Our aim is to confirm the pivotal role of Over-The-Scope Clip for menagement of perforation occurred during the ESD.

Methods Our Centre started the ESD techinque from March 2023 by an expert endoscopist, with a collegue in training, and we have included in a database the information of all procedures carried out from that period to September 2023.

Results Were included 34 adult patient (M/F: 19/15) with an age mean of 69 years. The mean lesions size was of 31 mm±20 for the upper-GI, 25 mm±15 for the lower-GI. Histological findings were reported in the tab. 1. All procedures were performed under general anesthetic care. Lesions were succesfully resected “en bloc” in all patients (100%) by ESD procedure using minimal CO2 insufflation. The overall intraprocedure perforation occured in 3 out of 34 (8,8%): 1 out of 18 was located in the upper-GI tract (fundus); 2 out of 16 lesions were located in the lower-GI tract (1 in the ascending colon and 1 in the discending colon, respectively). According to clinical and medical stability of the patients, all the parietal defect were treated successfully, at the end of the complete ESD, by positioning over-the-scope clip, allowing a full-thickness closure of the GI tract defect, avoiding emergency surgery. The R0 rate was of 94.1%, with two cases that underwent to surgery beacause of “pT2” at the final histological report.

Conclusions Over-the-scope clip is a known safe and efficacy device for closing perforation occured during ESD, in the course of the same endosocpic procedure. More and larger studies are needed to further validate these findings.

Publication History

Article published online:
15 April 2024