Low delayed bleeding and high complete closure rate of mucosal defects with the novel through-the-scope dual-action tissue clip after endoscopic resection of large nonpedunculated colorectal lesions (with video).

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.)