Novel through-the-scope suture closure of colonic EMR defects (with video)

Danse Bi, Linda Y. Zhang, Mohammad Alqaisieh, Apurva Shrigiriwar, Jad Farha, Tala Mahmoud, Karl Akiki, Jose Antonio Almario, Sardar M. Shah-Khan, Stuart R. Gordon, Jeffrey M. Adler, Mark Radetic, Peter V. Draganov, Yakira N. David, Brianna Shinn, Zahraa Mohammed, Alexander Schlachterman, Sofia Yuen, Ahmad Al-Taee, Namn YunseokRoberto Trasolini, Michael Bejjani, Bachir Ghandour, Hemchand Ramberan, Andrew Canakis, Saowanee Ngamruengphong, Andrew C. Storm, Shailendra Singh, Heiko Pohl, Juan Carlos Bucobo, Jonathan M. Buscaglia, Lionel S. D'Souza, Bashar Qumseya, Nikhil A. Kumta, Anand Kumar, Gregory B. Haber, Hiroyuki Aihara, Mandeep Sawhney, Raymond Kim, Tyler M. Berzin, Mouen A. Khashab

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background and Aims: Large colon polyps removed by EMR can be complicated by delayed bleeding. Prophylactic defect clip closure can reduce post-EMR bleeding. Larger defects can be challenging to close using through-the-scope clips (TTSCs), and proximal defects are difficult to reach using over-the-scope techniques. A novel, through-the-scope suturing (TTSS) device allows direct closure of mucosal defects without scope withdrawal. The goal of this study was to evaluate the rate of delayed bleeding after the closure of large colon polyp EMR sites with TTSS. Methods: A multicenter retrospective cohort study was performed involving 13 centers. All defect closure by TTSS after EMR of colon polyps ≥2 cm from January 2021 to February 2022 were included. The primary outcome was rate of delayed bleeding. Results: A total of 94 patients (52% female; mean age, 65 years) underwent EMR of predominantly right-sided (n = 62 [66%]) colon polyps (median size, 35 mm; interquartile range, 30-40 mm) followed by defect closure with TTSS during the study period. All defects were successfully closed with TTSS alone (n = 62 [66%]) or with TTSS and TTSCs (n = 32 [34%]), using a median of 1 (interquartile range, 1-1) TTSS system. Delayed bleeding occurred in 3 patients (3.2%), with 2 requiring repeated endoscopic evaluation/treatment (moderate). Conclusion: TTSS alone or with TTSCs was effective in achieving complete closure of all post-EMR defects, despite a large lesion size. After TTSS closure with or without adjunctive devices, delayed bleeding was seen in 3.2% of cases. Further prospective studies are needed to validate these findings before wider adoption of TTSS for large polypectomy closure.

Original languageEnglish
Pages (from-to)122-129
Number of pages8
JournalGastrointestinal Endoscopy
Issue number1
StatePublished - Jul 2023
Externally publishedYes


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