LAUSR

BACKGROUND Complete closure of large mucosal defects following colorectal ESD with through-the-scope clips (TTSC) is oftentimes not possible. We aimed to report an early experience of using a novel through-the-scope suturing system (TTSS) for closing large mucosal defects after colorectal ESD. METHODS We performed a retrospective, multi-center cohort study of consecutive patients who underwent attempted prophylactic defect closure using TTSS after colorectal ESD. The primary outcome was technical success in achieving complete defect closure, defined as (<5mm) residual mucosal defect in the closure line using TTSS with or without adjuvant TTSC. RESULTS Eighty-two patients with a median defect size of 30 mm [25-40] were included. Technical Success was achieved in 92.7% (n=76) using TTSS only in 44(53.7%) and a combination of TTSS to approximate the widest segment followed by complete closure with TTSCs in 32(39%) patients. Incomplete/partial closure, failure of appropriate TTSS deployment, and need for over-the-scope salvage closure methods were observed in 7.3%(n=6). One intraprocedural bleed, 1 delayed bleed, and 3 intraprocedural perforations were observed. There were no adverse events related to the placement of TTSS. CONCLUSION TTSS is an effective and safe tool for the closure of large mucosal defects after colorectal ESD and is an alternative when complete closure with TTSC alone is not possible.