Reply to Liu et al.

We appreciate the interest of Liu et al. in our article on the use of a novel through-the-scope (TTS) helix tack-and-suture (TTSS) device for mucosal defect closure following colorectal endoscopic submucosal dissection (ESD). In our study, we highlighted the early experience of 12 tertiary care centers in defect closure post-colorectal ESD using the TTSS device.

Liu et al. highlight the economic concept of opportunity cost that faces endoscopists when they set out to use a TTSS device instead of TTS clips (TTSCs) for ESD defect closure. To date, there is a paucity of literature directly comparing TTSS and TTSC in terms of procedure duration and technical success when controlling for baseline patient and lesion characteristics. We encourage prospective comparative and cost-effectiveness studies that would estimate and apply a dollar amount to the potential utility of time incurred by the use of the less efficient device.

Notably, the median tumor size in our study was 30 mm (interquartile range 25–40 mm), and several studies in the literature report a complete closure rate ranging from 57 % to 68 % for TTSC monotherapy for large (≥ 20 mm) nonpedunculated colorectal lesions; the aforementioned does not support the 100 % success rate described by Liu et al. [1] [2] [3]. Although the optimal indications for colorectal ESD defect closure are not yet well defined, recent studies have shed light on the benefits of prophylactic closure in terms of delayed bleeding and perforation [4] [5].

We would like to emphasize that our study did not compare the efficacy of TTSS with that of TTSC closure; however, we demonstrated that these two TTS modalities can be synergistically used to optimize the closure of complex resection defects. In agreement with the authors, we encourage future studies that seek to compare TTSS with the current standard of care to better understand which scenarios would benefit from its implementation.

Publication History

Article published online:
27 July 2023

• References

• 1 Pohl H, Grimm IS, Moyer MT. et al. Clip closure prevents bleeding after endoscopic resection of large colon polyps in a randomized trial. Gastroenterology 2019; 157: 977-984
• 2 Albéniz E, Fraile M, Ibáñez B. et al. A scoring system to determine risk of delayed bleeding after endoscopic mucosal resection of large colorectal lesions. Clin Gastroenterol Hepatol 2016; 14: 1140-1147
• 3 Albéniz E, Álvarez MA, Espinós JC. et al. Clip closure after resection of large colorectal lesions with substantial risk of bleeding. Gastroenterology 2019; 157: 1213-1221
• 4 Omori J, Goto O, Habu T. et al. Prophylactic clip closure for mucosal defects is associated with reduced adverse events after colorectal endoscopic submucosal dissection: a propensity-score matching analysis. BMC Gastroenterol 2022; 22: 139
• 5 Jiang W, Cen L, Dong C. et al. Prophylactic clipping to prevent delayed bleeding and perforation after endoscopic submucosal dissection and endoscopic mucosal resection: a systematic review and meta-analysis. J Clin Gastroenterol 2022; 56: 643-653