Search

Background and Aims: Postoperative stricture is a serious common adverse event after extensive endoscopic submucosal dissection (ESD) in the esophagus. Self-assembling peptide (SAP) gel has been shown to promote tissue healing and re-epithelialization. The aim of this study was to evaluate the effect of the SAP gel for esophageal stricture prevention after ESD., Methods: This was a multicenter prospective study of patients who underwent esophageal ESD followed by SAP gel application between March 2022 and December 2023. Patients were included if the ESD mucosal defect involved ≥50% of the circumference of the esophagus. High-risk cases were defined as mucosal defects ≥75% of the circumference. Stricture was defined as the inability to pass an endoscope ≥8.9 mm in diameter or a narrow-caliber lumen in a patient with symptoms., Results: A total of 43 patients (median age, 71 years; 81.4% male) underwent ESD (median resected specimen size, 50 mm) during the study period. SAP gel (median, 3 mL) was successfully applied in all cases (median time, 4 minutes). In aggregate, stricture occurred in 20.9% (9 of 43) of the cases. Stricture developed in 30.8% of the high-risk cases: 80% (4 of 5) after circumferential ESD and 19% (4 of 21) in those with defects ≥75% but <100% of the circumference. All cases of stricture resolved with endoscopic treatment. Three cases (6.9%) of postoperative bleeding occurred and were adequately managed endoscopically., Conclusions: We show that SAP gel application was easy, quick, and associated with a relatively low stricture rate comparable to other prophylactic methods. Additional comparative studies are needed to corroborate these preliminary findings., Competing Interests: Disclosure D. Yang: consultant for Olympus, Fujifilm, Boston Scientific, Medtronic, 3D-Matrix, Microtech, and Neptune Medical; and research grants from Microtech and 3D-Matrix. M. K. Hasan: consultant for Boston Scientific, Olympus, Neptune Medical, and Microtech. M. Gabr: consultant for Boston Scientific, Olympus, ConMed, 3D-Matrix, Fujifilm, and Adaptiv Endo. S. Jawaid: consultant for Lumendi, Creo Medical, and ConMed. M. Othman: consultant for Olympus, Boston Scientific, Creo Medical, Apollo Endosurgery, Lumendi, AbbVie, and Nestle; and research support from Boston Scientific, ConMed, Lucid Diagnostic, AbbVie, and Nestle. M. J. Rojas De Leon: Consultant for Boston Scientific. N. Sharma: consultant for Boston Scientific, Medtronic, Steris, and Olympus. P. V. Draganov: consultant for Olympus, Fujifilm, Boston Scientific, Medtronic, Microtech, Cook Medical, and 3D-Matrix. All other authors disclosed no financial relationships. The study was supported by a research grant from 3D-Matrix. 3D-Matrix was not involved in the design of the study, its conduct, analysis, or interpretation of study results. None of the authors participated in the development of the self-assembling peptide gel or benefit from its sales., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Background and Aims: Complete closure after endoscopic resection of large nonpedunculated colorectal lesions (LNPCLs) can reduce delayed bleeding but is challenging with conventional through-the-scope (TTS) clips alone. The novel dual-action tissue (DAT) clip has clip arms that open and close independently of each other, facilitating tissue approximation. We aimed to evaluate the rate of complete closure and delayed bleeding with the DAT clip after endoscopic resection of LNPCLs., Methods: This was a multicenter prospective cohort study of all patients who underwent defect closure with the DAT clip after EMR or endoscopic submucosal dissection (ESD) of LNPCLs ≥20 mm from July 2022 to May 2023. Delayed bleeding was defined as a bleeding event requiring hospitalization, blood transfusion, or any intervention within 30 days after the procedure. Complete closure was defined as apposition of mucosal defect margins without visible submucosal areas <3 mm along the closure line., Results: One hundred seven patients (median age, 64 years; 42.5% women) underwent EMR (n = 63) or ESD (n = 44) of LNPCLs (median size, 40 mm; 74.8% right-sided colon) followed by defect closure. Complete closure was achieved in 96.3% (n = 103) with a mean of 1.4 ± .6 DAT clips and 2.9 ± 1.8 TTS clips. Delayed bleeding occurred in 1 patient (.9%) without requiring additional interventions., Conclusions: The use of the DAT clip in conjunction with TTS clips achieved high complete defect closure after endoscopic resection of large LNPCLs and was associated with a .9% delayed bleeding rate. Future comparative trials and formal cost-analyses are needed to validate these findings. (Clinical trial registration number: NCT05852457.)., Competing Interests: Disclosure The following authors disclosed financial relationships: M. K. Hasan: Consultant for Boston Scientific, Olympus, and Microtech. A. Saeed: Consultant for Boston Scientific, Olympus, Endogastric Solutions, and Medtronic. S. Friedland: Consultant for Intuitive and Capsovision. M. Bilal: Consultant for Boston Scientific. N. Sharma: Consultant for Boston Scientific, Medtronic, Steris, and Olympus. S. Jawaid: Consultant for Lumendi, Creo Medical, Boston Scientific, and ConMed. M. Othman: Consultant for Olympus, Boston Scientific, Creo Medical, Apollo Endosurgery, Lumendi, Abbvie, and Nestle; research support from Boston Scientific, ConMed, Lucid Diagnostic, Abbvie, and Nestle. J. H. Hwang: Consultant for Boston Scientific, Olympus, Medtronic, Microtech, Lumendi, Neptune, and Fujifilm. N. Cosgrove: Consultant for Boston Scientific and Olympus. M. A. Arain: Consultant for Boston Scientific, Olympus, and Cook Medical. D. Yang: Consultant for Olympus, Fujifilm, Boston Scientific, Medtronic, 3D-Matrix, Microtech, and Neptune Medical; research grants from Microtech and 3D-Matrix. All other authors disclosed no financial relationships. Research support for this study (D.Y.) was provided by Microtech., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)