Innovative Closure Strategy for Rectal Defects Post-Endoscopic Submucosal Dissection

Researchers introduced an endoscopic hand-suturing with clips strategy (EHS-clips) for closing rectal defects after endoscopic submucosal dissection (ESD) or ESD with myectomy. All 49 defects achieved complete closure, with 71.4% through EHS alone and 28.6% with additional clips. Zero cases experienced delayed bleeding. Sustained closure reached 73.5% on postoperative days 3-5, with a stitch margin of ≥ 5 mm identified as the sole independent factor favoring sustained closure. EHS-clips effectively prevent delayed bleeding, and a wider stitch margin enhances sustained closure reliability.