Post written by Samuel Han, MD, from the Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.

In this Tools and Techniques video, we describe a formalized technique to close defects created by ESD using endoscopic suturing. Essentially, we suggest proceeding from the site most distal to the scope insertion site and proceeding in a left-to-right, right-to-left manner until the site most proximal to the scope insertion site is reached. This maximizes visibility during the suturing to decrease its level of difficulty.

We wanted to showcase this technique to offer a formalized way to close these post-ESD defects. Given that a variety of suturing methods exist, but few have been published for endoscopic suturing, we hope this provides a practical approach to suturing these defects closed. We also hope that this technique can be assessed prospectively in a multi-center manner to see if it can help prevent adverse events associated with ESD, including delayed perforation and bleeding.

We believe that endoscopists can learn a simple but effective technique to suture post-ESD defects. We also hope that endoscopists will consider closing these defects in an effort to minimize the adverse event rate of ESD and potentially allow for same-day discharge.

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