“CLIP-BAND CLOSURE” TECHNIQUE FOR COLORECTAL PERFORATION AND LARGE MUCOSAL DEFECTS AFTER COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION

Introduction:

We describe for the first time the clip-band closure (CBC) technique for successful management of extra-large mucosal defects and perforations associated with colorectal endoscopic submucosal dissection (CR-ESD).

Procedure:

CBC technique has been described for traction purposes and preventive closure of duodenal defects. It consists on the use of a regular orthodontic rubber band grasped with a through-the-scope clip (TTSC) that is applied to one of the mucosal defect margins. Afterwards, a second TTSC is inserted to grasp the free part of the band and pulling it to deploy the clip in the opposite edge of the mucosal defect, aiming to create tension to effectively approach the mucosal edges, thus facilitating the complete closure of the defect with extra TTSC.

Results:

We present CBC application to manage a large CR-ESD associated perforation. An 88-year-old patient presented with a 70 × 70 mm LST-G mixed type (0-Is + IIa) in ascending colon. ESD with en-bloc resection was completed and an extensive area of the muscular layer showed significant disruption. Because of the broad area resected it was not feasible to close it by conventional clipping. We performed four CBC “combos” to achieve apposition of both edges of the mucosal defect, followed by the deployment of extra 30 TTSCs until completing the full closure. The patient was discharged uneventfully 24h after the procedure, with no delayed complications 3 months follow-up.

Conclusions:

CBC technique is a simple and useful method for complete closure of large mucosal defects after CR-ESD, even in proximal colon, without requiring special devices or repeated intubation like traction-line technique.