Evaluation of Updated Double-Layered Suturing for Post-Colorectal ESD Mucosal Defects

[Background] We previously introduced Double-Layered Suturing (DLS) to minimize dead space in post-colorectal ESD mucosal defects by simulating seromuscular apposition via muscle fold inclusion. However, conventional DLS has limitations in closing large mucosal defects. Updated DLS, incorporating an anchor-pronged clip (MANTIS clip; Boston Scientific, USA), enhances closure stability, eliminates endoscope re-insertion, and improves cost-effectiveness compared to other closure devices. [Objective] To evaluate the short-term clinical outcomes of Updated DLS for post-colorectal ESD mucosal defects. [Methods] A retrospective analysis was conducted on 24 lesions treated with Updated DLS. Clinical and procedural outcomes, including closure success rate, procedure time, and post-procedural complications, were assessed. [Results] Lesion locations: Cecum (n=4), Ascending (n=4), Transverse (n=11), Descending (n=1), Sigmoid (n=2), Rectum (n=2). Median tumor size: 30 mm [26.5-39]. Median resected size: 44 mm [40-56.5]. En bloc/R0 resection rates: 100% / 91.6%. Closure rate: 100%. Closure time: 15 min [14-20]. Complications: PECS in 5 cases (20.8%), all managed conservatively. [Conclusion] Updated DLS enables effective closure of even larger mucosal defects, achieving seromuscular-layer-like closure while eliminating endoscope re-insertion. It is a safe, practical, and cost-effective closure technique. Further studies are needed to expand indications and compare efficacy with conventional DLS.