Prevention of late complications with coverage agents in endoscopic resection of colorectal lesions: Current landscape in gastrointestinal endoscopy

Abstract

Endoscopic removal of large (≥ 20 mm) non-pedunculated colorectal lesions (LNPCLs) may result in major adverse events, such as delayed bleeding (DB) and delayed perforation (DP), despite closure of the mucosal defects with clips. Topical application of a coverage agent refers to the creation of a shield with a biocompatible medical device (tissue or hydrogel) with proven bioactive properties. Coverage of the eschar after endoscopic resection provides shielding protection to prevent delayed complications. The aim of the present review was to systematically collect and review the currently available literature regarding the prevention of DB and DP with coverage agents after endoscopic mucosal resection or endoscopic submucosal dissection of LNPCLs.

Keywords: Large colorectal lesions; Delayed bleeding; Topical application; Endoscopic mucosal resection; Endoscopic submucosal dissection

Core Tip: The use of coverage agents is the simplest and quickest technique to protect large mucosal defects. Published data have confirmed their efficacy in the prevention of delayed adverse events in patients with non-pedunculated colorectal lesions, especially in proximal lesions with an increased risk of bleeding of at least 2-fold. There are no comparative studies that address the best treatment. We herein review the current landscape of the available agents in gastrointestinal endoscopy.