CURRENT STATUS OF POST- ENDOSCOPIC SUBMUCOSAL DISSECTION DEFECT CLOSURE IN THE GASTROINTESTINAL TRACT

Abstract

Endoscopic submucosal dissection（ESD）is a curative, minimally invasive treatment for early gastrointestinal cancer. However, preventing post-ESD adverse events, such as delayed bleeding and perforation, remains challenging. With an aging population, more patients are receiving antithrombotic therapy, and the risk of bleeding is clinically significant. Because the incidence and severity of adverse events vary by organ, individualized strategies based on risk stratification that incorporate organ- and patient-related factors are required. Recently, endoscopic defect closure has attracted attention as a preventive strategy with accumulating evidence supporting its efficacy. This review outlines the organ-specific incidence of post-ESD adverse events and summarizes the clinical significance of prophylactic defect closure based on the literature. Closure techniques are categorized as through-the-scope clips, over-the-scope systems, endoscopic suturing, and shielding methods, and their characteristics are briefly described. Further evidence is required to establish optimal strategies that consider organ-specific indications, risk profiles, and technical and economic factors.