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DOI: 10.1055/a-2055-7402
Underwater clipping in the colon
Clipping closure of large mucosal defects in the gastrointestinal tract can be difficult and time consuming, and sometimes requires many clips as the mucosa surrounding the defect stretches following endoscopic mucosal resection (EMR). Techniques utilizing the underwater method have been increasingly used in various endoscopic procedures [1] [2] [3]. Its application in clipping has been reported in large colonic and duodenal endoscopic submucosal dissection [4]. Here, we demonstrate the use of underwater clipping after EMR in the colon ([Video 1]).
Video 1 Underwater clipping after colonic polypectomy in a 72-year-old man.
Quality:
A 72-year-old man underwent a screening colonoscopy in which a 15-mm sessile elevated polyp (laterally spreading tumor, nongranular type) was discovered in the ascending colon ([Fig. 1]). Narrow-band imaging revealed adenoma with no invasive findings ([Fig. 2]). En bloc underwater EMR was performed using a bipolar snare (Dragonare; Zeon Medical Inc., Tokyo, Japan) ([Fig. 3]). After the defect had been examined, and confirmation had been obtained with carbon dioxide that there was no perforation, the lumen was filled with saline. The tension of the mucosa around the defect decreased and the mucosa floated ([Fig. 4]). The defect size decreased, making it easier to catch the mucosa with the clips (SureClip; Micro-Tech, Nanjing, China). The defect was completely closed with four clips ([Fig. 5]). Underwater clipping was easier than the conventional under-gas method; it reduced both the procedure time and the number of clips.
Endoscopy_UCTN_Code_TTT_1AQ_2AZ
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Publication History
Article published online:
28 June 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Binmoeller KF, Weilert F, Shah J. et al. ‘Underwater’ EMR without submucosal injection for large sessile colorectal polyps (with video). Gastrointest Endosc 2012; 75: 1086-1091
- 2 Yamamoto S, Ishida H, Mita E. Acetic acid-assisted underwater endoscopic mucosal resection for successful resection of sessile serrated lesions. Endoscopy 2022; 54: E508-E509
- 3 Yamamoto S, Parra-Blanco A. Underwater endoloop-assisted endoscopic resection for colorectal pedunculated polyps. Endoscopy 2022; 54: E835-E836
- 4 Yamasaki Y, Harada K, Oka S. et al. Feasibility of underwater clip closure for large mucosal defects after colorectal endoscopic submucosal dissection. Digestion 2019; 99: 327-332