This is a pilot study to investigate the usefulness of closure of mucosal defect after gastric endoscopic submucosal dissection (ESD) in patients that are at high risk of post-procedural haemorrhage. Delayed haemorrhage is still an important adverse event of ESD, occurring more frequently for gastric lesions. Risk factors identified for delayed haemorrhage include chronic kidney disease, use of antithrombotic agent, lesion size \>20mm, specimen size \>30mm. Current established methods to prevent this complications could not completely eliminate the chance of bleeding, especially among high-risk cases. Closure of ESD defect may prevent ongoing exposure of submucosal vessels to gastric acid, and further reduce the risk of delayed haemorrhage. The investigators conduct this study to investigate the effect of closing the defect with endoscopic clips and loop. 30 patients who are undergoing gastric ESD deemed high risk of delayed haemorrhage would be recruited, with closure of defect after resection. The rate of delayed haemorrhage would be compared with historical cohort of patients.
Who can participate
Age range18 Years
SexALL
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AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.
✓. Procedure deemed at high risk of post-procedural hemorrhage due to the following:
✓. End stage renal disease (Estimated GFR \<15ml/min)
✓. Patients on anti-thrombotic agents (Double antiplatelet, warfarin or direct oral anticoagulants)
✓. Post ESD mucosal defect size \>4cm
✓. Target subjects receiving sufficient briefing from the attending physician regarding the content of this study and providing informed consent for participation
✓. Over 20 years of age
Exclusion criteria
✕. Recurrent / remnant lesion after previous endoscopic resection
✕. Lesions arising from surgical anastomotic site, such as gastrojejunostomy / gastroduodenostomy.