Clinical Endoscopy

Original Article

Effect of double-layered suturing for mucosal defect closure after colorectal endoscopic submucosal dissection on postoperative adverse events: a propensity score-matched retrospective study in Japan: Kyohei Nishino, Hiroki Fujita, Takahiro Yuge, Masanori Hongo, Naoko Mori, Kazumi Shimamoto, Yu Kobayashi, Takashi Toyonaga, Hiromitsu Ban; Clin Endosc 2025;58(6):881-889. Published online November 6, 2025; DOI: https://doi.org/10.5946/ce.2025.053

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Background
/Aims: Prophylactic closure of mucosal defects after colorectal endoscopic submucosal dissection (ESD) can reduce the incidence of postoperative adverse events. However, data on this notion are limited. This study retrospectively evaluated the effect of closure using a double-layered suturing technique on postoperative adverse events.
Methods
A total of 370 lesions in 317 patients who underwent colorectal ESD were included in this analysis. Patients with 197 lesions that were completely closed were then assigned to the closure group. Patients with 173 lesions, including 55 that were partially closed and 118 that were not closed, were assigned to the non-closure group. Propensity score matching was performed, and 136 lesions were selected for each group.
Results
The closure group had a significantly lower overall incidence rate of postoperative adverse events, including delayed bleeding, delayed perforation, and post-ESD electrocoagulation syndrome, than the non-closure group (2.2% vs. 9.6%, p=0.018). The closure group had a significantly lower incidence of abdominal pain on the day after ESD than the non-closure group (2.9% vs. 11.0%, p=0.015).
Conclusions
Prophylactic closure of mucosal defects after colorectal ESD using a double-layered suturing technique could prevent postoperative adverse events and abdominal pain on the day after ESD.

Citations

Citations to this article as recorded by

Colorectal endoscopic submucosal dissection defect closure: promising but still evolving
Yunho Jung
Clinical Endoscopy.2025; 58(6): 856. CrossRef

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Reviews

Endoscopic full-thickness resection of upper gastrointestinal tract: a review on closure techniques: Siew Fung Hau, Shannon Melissa Chan; Clin Endosc 2026;59(2):171-181. Published online September 29, 2025; DOI: https://doi.org/10.5946/ce.2025.037

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Endoscopic full-thickness resection has become more and more popular. One of the most important parts of this procedure is the closure of these full-thickness defects. Apart from conventional through-the-scope (TTS) clips, several different methods and devices have emerged as safe and efficacious in recent years. New clips include the anchor pronged TTS clips, dual-action tissue clips, and over-the-scope-clips. There are also new line or loop-assisted closure methods such as clip loop method, reopenable clip over line method, loop 9 method, and the internal-traction-assisted suspended closure method. New devices include the helical tacking system and endoscopic suturing device. This review article will discuss in details the usage of these different methods and available literature on comparison between the different closure methods.

Citations

Citations to this article as recorded by

Technische Fortschritte in der endoskopischen Resektion
Sandra Nagl, Johannes Wießner, Katharina Beyer, Helmut Messmann
Die Innere Medizin.2026; 67(1): 11. CrossRef

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Endoscopic Closure for Full-Thickness Gastrointestinal Defects: Available Applications and Emerging Innovations: Nobuyoshi Takeshita, Khek Yu Ho; Clin Endosc 2016;49(5):438-443. Published online August 30, 2016; DOI: https://doi.org/10.5946/ce.2016.104

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Full-thickness gastrointestinal defects such as perforation, anastomotic leak, and fistula are severe conditions caused by various types of pathologies. They are more likely to require intensive care and a long hospital stay and have high rates of morbidity and mortality. After intentional full-thickness opening of hollow organs for natural orifice transluminal endoscopic surgery, safe and secure closure is urgently required. The currently available advanced endoscopic closing techniques have a major role in the treatment of full-thickness gastrointestinal defects. Appropriate usage of these techniques requires taking into account their advantages and limitations during practical application. We reviewed the available endoscopic modalities, including endoscopic clips, stents, vacuum-assisted closure, gap filling, and suturing devices, discussed their advantages and limitations when treating full-thickness gastrointestinal defects, and explored emerging innovations, including a novel endoluminal surgical platform for versatile suturing and a cell-laden scaffold for effective gap filling. Although these emerging technologies still require further pre-clinical and clinical trials to assess their feasibility and efficacy, the available modalities may be replaced and refined by these new techniques in the near future.

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Recent Advanced Endoscopic Management of Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforations: Seon Mee Park; Clin Endosc 2016;49(4):376-382. Published online July 29, 2016; DOI: https://doi.org/10.5946/ce.2016.088

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The management strategy for endoscopic retrograde cholangiopancreatography-related duodenal perforation can be determined based on the site and extent of injury, the patient’s condition, and time to diagnosis. Most cases of perivaterian or bile duct perforation can be managed with a biliary stent or nasobiliary drainage. Duodenal wall perforations had been treated with immediate surgical repair. However, with the development of endoscopic devices and techniques, endoscopic closure has been reported to be a safe and effective treatment that uses through-the-scope clips, ligation band, fibrin glue, endoclips and endoloops, an over-the-scope clipping device, suturing devices, covering luminal stents, and open-pore film drainage. Endoscopic therapy could be instituted in selected patients in whom perforation was identified early or during the procedure. Early diagnosis, proper conservative management, and effective endoscopic closure are required for favorable outcomes of non-surgical management. If endoscopic treatment fails, or in the cases of clinical deterioration, prompt surgical management should be considered.

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