Endoscopy 2020; 52(01): E20-E21
DOI: 10.1055/a-0979-4027
E-Videos
© Georg Thieme Verlag KG Stuttgart · New York

New ligation technique using a double loop clip without adhesive for ulceration following endoscopic submucosal dissection of the colon

Satoshi Abiko
Department of Gastroenterology, Kushiro Rosai Hospital, Kushiro, Japan
,
Ayumu Yoshikawa
Department of Gastroenterology, Kushiro Rosai Hospital, Kushiro, Japan
,
Kazuaki Harada
Department of Gastroenterology, Kushiro Rosai Hospital, Kushiro, Japan
,
Naoki Kawagishi
Department of Gastroenterology, Kushiro Rosai Hospital, Kushiro, Japan
,
Itsuki Sano
Department of Gastroenterology, Kushiro Rosai Hospital, Kushiro, Japan
,
Hisashi Oda
Department of Gastroenterology, Kushiro Rosai Hospital, Kushiro, Japan
,
Takuto Miyagishima
Department of Gastroenterology, Kushiro Rosai Hospital, Kushiro, Japan
› Author Affiliations
Further Information

Corresponding author

Satoshi Abiko, MD
Department of Gastroenterology
Kushiro Rosai Hospital
13-23, Nakazono-cho
Kushiro 085-8533
Japan   
Fax: +81-154-257308   

Publication History

Publication Date:
13 August 2019 (online)

 

Various ligation techniques for post-endoscopic submucosal dissection (ESD) ulceration have recently been reported [1] [2] [3] [4] [5]; however, no technique has been established owing to the complexity involved and the fact that an expensive device is required. We devised a new ligation technique using a double loop clip (D-L clip) without an adhesive agent for ulceration following ESD of the colon.

First, a standard clip (HX-610-90; Olympus, Tokyo, Japan) is attached to a rotatable clip-fixing device. The clip is deployed, and before deployment is completed, a thread, which is tied loosely in advance, is passed through the portion intersecting the clip arm at the base of the clip and tied. Next, a double loop of appropriate length is created using the remaining thread. The clip is drawn back again into the rotatable clip-fixing device. This completes the D-L clip without the use of an adhesive agent ([Fig. 1]). The D-L clip is applied to the proximal side of the post-ESD ulcer area ([Fig. 2]). Clipping of the mucous membrane on the distal side is performed by applying a different clip to the proximal or distal loop line in each situation. We usually pick up the proximal loop line. A clip is then added to tighten the ligation, thereby completing the ligation ([Video 1]).

Zoom Image
Fig. 1 Method of making a D-L clip without an adhesive. a, b The clip is deployed, and before deployment is completed, a thread, which is tied loosely in advance, is passed through the portion intersecting the clip arm at the base of the clip and tied. c A double loop of appropriate length is created using the remaining thread. d This completes the D-L clip without the use of an adhesive agent.
Zoom Image
Fig. 2 Ulceration following endoscopic submucosal dissection (ESD) of the colon (34 mm in diameter). The D-L clip is applied to the proximal side of the post-ESD ulcer area.

Video 1 Method for making a D-L clip without an adhesive, and demonstration of the ligation technique using the D-L clip for ulceration following endoscopic submucosal dissection of the colon.


Quality:

We previously used a single loop clip, but it was sometimes difficult to pick up the

loop line, because the loop line was crumpled. In this new technique, the weight of the distal loop moderately extends the proximal loop line. We can easily pick up the proximal loop line, and if we cannot pick up one loop line, we can try to pick up the other loop line.

The ligation technique using a D-L clip without an adhesive agent is a useful technique that is simple and cost-effective.

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Competing interests

None


Corresponding author

Satoshi Abiko, MD
Department of Gastroenterology
Kushiro Rosai Hospital
13-23, Nakazono-cho
Kushiro 085-8533
Japan   
Fax: +81-154-257308   


Zoom Image
Fig. 1 Method of making a D-L clip without an adhesive. a, b The clip is deployed, and before deployment is completed, a thread, which is tied loosely in advance, is passed through the portion intersecting the clip arm at the base of the clip and tied. c A double loop of appropriate length is created using the remaining thread. d This completes the D-L clip without the use of an adhesive agent.
Zoom Image
Fig. 2 Ulceration following endoscopic submucosal dissection (ESD) of the colon (34 mm in diameter). The D-L clip is applied to the proximal side of the post-ESD ulcer area.