# Safety outcomes of mucomuscular closure versus conventional clip closure in ESD of large (> 15 mm) nonpedunculated colorectal polyps (LNPCPs)

## TL;DR

A new technique for closing colorectal ESD defects reduces a common complication called PEECS and improves safety outcomes.

## Contribution

The mucomuscular closure technique using through-the-scope clips is introduced as a safer alternative to conventional closure methods.

## Key findings

- Mucomuscular closure reduced PEECS incidence to 2.5% compared to 15.0% with conventional closure.
- No severe adverse events occurred in the mucomuscular closure group, unlike the conventional group.
- PEECS rates were similar regardless of complete or partial closure in the mucomuscular group.

## Abstract

Post-endoscopic submucosal dissection (ESD) electrocoagulation syndrome (PEECS) is a recognized limitation of colorectal ESD (C-ESD) associated with morbidity, additional costs, and prolonged admission. Reliable closure of C-ESD defects can decrease the incidence of PEECS. We introduce a novel mucomuscular closure technique that involves direct closure of the muscularis propria using through-the-scope clips (TTSC). We evaluate the feasibility and efficacy of the modified closure technique in prevention of post-C-ESD PEECS.

We conducted a prospective cohort study of consecutive C-ESDs at a single tertiary center between January 2017 and October 2023. Patients who underwent C-ESD with mucomuscular closure or conventional closure with TTSC were enrolled. The primary outcome was the incidence and clinical outcome of PEECS. Secondary outcomes were rates of complete defect closure and severe adverse events (SAEs).

A total of 764 patients were included in this study. The incidence of PEECS was significantly lower in the mucomuscular closure group versus conventional closure group (2.5% versus 15.0%, P < 0.001). No SAEs occurred in mucomuscular closure group, whereas two patients had delayed perforation, and two had delayed bleeding in the conventional closure group. In mucomuscular closure group, there was no difference in PEECS occurrence between complete closure (5/218, 2.3%) and partial closure (3/105, 2.9%). No TTSC-related perforation occurred in the process of defect closure.

Mucomuscular closure with TTSC in C-ESDs is effective in preventing PEECS and other postoperative complications.

The online version contains supplementary material available at 10.1007/s10151-025-03261-w.