“Hold-and-drag” closure technique using repositionable clips for large mucosal defects after colonic endoscopic submucosal dissection

Background and study Aims: To prevent complications after colonic endoscopic submucosal dissection (ESD), we developed a new closure technique using repositionable clips.

Patients and methods: The closure of post-ESD mucosal defects was attempted in 19 cases. Mucosal defects were linearly closed by holding and dragging the anal mucosal edge towards the oral mucosal edge using repositionable clips. Standard hemoclips were additionally placed to complete the closure. We retrospectively assessed the feasibility of this technique.

Results: Defect closure was successfully completed in 18 cases (94.7 %). The mean defect size and the procedural time were 40.2 ± 12.0 mm (range, 24 – 71 mm) and 10.7 ± 7.2 min (range, 4.0 – 29.9 min), respectively. The mean number of repositionable clips and standard clips required for closure was 1.6 ± 0.8 (range, 1 – 3) and 7.3 ± 3.7 (range, 3 – 16), respectively. No adverse events occurred during procedures and thereafter (95 % confidence interval, 0 – 17.6 %).

Conclusions: The new closure technique for large mucosal defects after colonic ESD using repositionable clips was feasible and appeared effective for preventing subsequent adverse events.

• References

• 1 Ono H, Kondo H, Gotoda T et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225-229
• 2 Oyama T, Tomori A, Hotta K et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 2005; 3: 67-70
• 3 Yahagi N, Uraoka T, Ida Y et al. Endoscopic submucosal dissection using the Flex and the Dual knives. Tech Gastroint Endosc 2011; 13: 74-78
• 4 Saito Y, Uraoka T, Yamaguchi Y et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72: 1217-1225
• 5 Cao Y, Liao C, Tan A et al. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy 2009; 41: 751-757
• 6 Matsuda T, Fujii T, Emura F et al. Complete closure of a large defect after EMR of a lateral spreading colorectal tumor when using a two-channel colonoscope. Gastrointest Endosc 2004; 60: 836-838
• 7 Sakamoto N, Beppu K, Matsumoto T et al. “Loop Clip”, a new closure device for large mucosal defects after EMR and ESD. Endoscopy 2008; 40: E97-E98
• 8 Fujii T, Ono A, Fu KI et al. A novel endoscopic suturing technique using a specially designed so-called “8-ring” in combination with resolution clips (with videos). Gastrointest Endosc 2007; 66: 1215-1220
• 9 Otake Y, Saito Y, Sakamoto T et al. New closure technique for large mucosal defects after endoscopic submucosal dissection of colorectal tumors (with video). Gastrointest Endosc 2012; 75: 663-667
• 10 Osada T, Sakamoto N, Ritsuno H et al. Process of wound healing of large mucosal defect areas that were sutured by using a loop clip-assisted closure technique after endoscopic submucosal dissection of a colorectal tumor. Gastrointest Endosc 2013; 78: 793-798
• 11 Shioji K, Suzuki Y, Kobayashi M et al. Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy. Gastrointest Endosc 2003; 57: 691-694
• 12 Feagins LA, Nguyen AD, Iqbal R et al. The prophylactic placement of hemoclips to prevent delayed post-polypectomy bleeding: an unnecessary practice? A case control study. Dig Dis Sci 2014; 59: 823-828
• 13 Liaquat H, Rohn E, Rex DK et al. Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions. Gastrointest Endosc 2013; 77: 401-407