Endosc Int Open 2016; 04(10): E1052-E1056
DOI: 10.1055/s-0042-113126
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Single clips versus multi-firing clip device for closure of mucosal incisions after peroral endoscopic myotomy (POEM)

Tessa Verlaan
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
Fraukje A. M. Ponds
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
Barbara A. J. Bastiaansen
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
Albert J. Bredenoord
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
Paul Fockens
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

submitted: 21 February 2016

accepted after revision: 13 June 2016

Publication Date:
21 September 2016 (online)

Background and aims: After Peroral Endoscopic Myotomy (POEM), the mucosal incision is closed with endoscopically applied clips. After each clip placement, a subsequent clipping device has to be introduced through the working channel. With the Clipmaster3, three consecutive clips can be placed without reloading which could reduce closure time. We performed a prospective study evaluating efficacy, safety, and ease of use. Closure using Clipmaster3 was compared to closure with standard clips.

Methods: Patients undergoing closure with the Clipmaster3 were compared to patients who underwent POEM with standard clip closure.

Results: In total, 12 consecutive POEM closures with Clipmaster3 were compared to 24 standard POEM procedures. The Clipmaster3 and the standard group did not differ in sex distribution, age (42 years [29 – 49] vs 41 years [34 – 54] P = 0.379), achalasia subtype, disease duration, length of the mucosal incision (25.0 mm [20 – 30] vs 20.0 mm [20 – 30], P = 1.0), and closure time (622 seconds [438 – 909] vs 599 seconds [488 – 664] P = 0.72). Endoscopically successful closure could be performed in all patients. The proportion of all clips used that were either displaced or discarded was larger for Clipmaster3 (8.8 %) compared to standard closure (2.0 %, P  = 0.00782). Ease of handling VAS (visual analogue scale) score for Clipmaster3 did not differ between endoscopist and endoscopy nurse (7 out of 10).

Conclusions: Clipmaster3 is feasible and safe for closure of mucosal incisions after POEM. Clipmaster3 was not associated with reduced closure time. Compared to standard closure, more Clipmaster3 clips were displaced or discarded to achieve successful closure. A training effect cannot be excluded as a cause of these results.

Study registration: NCT01405417

 
  • References

  • 1 Inoue H, Minami H, Kobayashi Y et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271
  • 2 NOSCAR POEM White Paper Committee. Stavropoulos SN, Desilets DJ, Fuchs KH et al. Per-oral endoscopic myotomy white paper summary. Gastrointest Endosc 2014; 80: 1-15
  • 3 Li QL, Zhou PH. Perspective on peroral endoscopic myotomy for achalasia: Zhongshan experience. Gut Liver 2015; 9: 152-158
  • 4 Patel KS, Calixte R, Modayil RJ et al. The light at the end of the tunnel: a single-operator learning curve analysis for per oral endoscopic myotomy. Gastrointest Endosc 2015; 81: 1181-1187
  • 5 Verlaan T, Rohof WO, Bredenoord AJ et al. Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia. Gastrointest Endosc 2013; 78: 39-44
  • 6 Meireles OR, Horgan S, Jacobsen GR et al. Transesophageal endoscopic myotomy (TEEM) for the treatment of achalasia: the United States human experience. Surg Endosc 2013; 27: 1803-1809
  • 7 Kurian AA, Bhayani NH, Reavis K et al. Endoscopic suture repair of full thickness esophagotomy during per-oral esophageal myotomy for achalasia. Surg Endosc 2013; 27: 3910
  • 8 Saxena P, Chavez YH, Kord Valeshabad A et al. An alternative method for mucosal flap closure during peroral endoscopic myotomy using an over-the-scope clipping device. Endoscopy 2013; 45: 579-581
  • 9 Li H, Linghu E, Wang X. Fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy (POEM). Endoscopy 2012; 44 (Suppl. 02) UCTN E215-E216
  • 10 Zhang Y, Wang X, Fan Z. Reclosure of ruptured incision after peroral endoscopic myotomy using endoloops and metallic clips. Dig Endosc 2014; 26: 295