Sa1574 Endoscopic Suture Closure Is Superior to Closure With Endoscopic Clips in Prevention of Delayed Complications After Removal of Large Sessile Gastro-Intestinal Tract Lesions

Sa1574 Endoscopic Suture Closure Is Superior to Closure With Endoscopic Clips in Prevention of Delayed Complications After Removal of Large Sessile Gastro-Intestinal Tract Lesions Sergey Kantsevoy*, Marianne Bitner, Jose M. Davis, Paulina Mirovski, Anurag Maheshwari, Sanjay B. Jagannath, Hwan Yoo, Paul J. Thuluvath Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD; Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD Background: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are commonly used to remove pre-malignant and early malignant lesions of gastro-intestinal (GI) tract. Delayed complications (bleeding, perforation) can occur 2-15 days post removal of large sessile GI tract lesions. Study Aim: To compare incidence of delayed complications in patients with and without endoscopic closure of mucosal defects post removal of large GI tract lesions. Methods: We reviewed all medical records of patients who had removal of large GI tract lesions at our hospital over the last 21 months (03/13-11/14). Size, location, pathology of lesion, removal method (EMR, ESD) ,endoscopic closure techniques (no closure, endoscopic clips closure or suture closure with endoscopic suturing device), and presence of delayed complications (bleeding, perforation) were entered into Excel Database and analyzed. Results: Total of 729 sessile lesions over 10 mm in size were removed in 508 patients; 240 lesions (32.9%) were removed by ESD, 489 lesions (67.1%) were removed by EMR. Lesions removed by ESD (mean size 30.9 16.1 mm) were significantly larger (p!0.0001) than lesions removed by EMR (mean size 16.1 10.1 mm). Following removal of 411 lesions (mean size 14.6 10.0 mm), the mucosal defect was left without closure. After removal of 127 lesions (mean size 23.4 9.9 mm) the mucosal defect was closed with 1-9 endoscopic clips (average 3.0 1.7 clips per closure). In 191 cases (average size 33.1 15.9 mm) the mucosal defect was closed with 1-4 endoscopic sutures (average 1.4 0.7 suture per closure). Defects closed with sutures were significantly larger (p!0.0001) then defects closed with the clips or the defects left without any endoscopic closure (p!0.0001). There were no delayed complications after endoscopic suture closure. To the contrary, there were 4 delayed bleedings (2.1%), and 2 delayed perforations (1.6%) after closure with endoscopic clips, 5 delayed bleedings (1.2%), and 4 delayed perforations (1.0%) when the mucosal defect was left without closure. Conclusion: Endoscopic suture closure of mucosal defects reliably prevents delayed complications after removal of large sessile GI tract lesions and is superior to mucosal defect closure with endoscopic clips.