Achieving reliable full-thickness defect closure after gastric endoscopic full-thickness
resection (EFTR) for gastrointestinal stromal tumors is challenging [1 ]
[2 ]. Although mucosal closure appears clinically acceptable [2 ]
[3 ]
[4 ], it is crucial to develop a robust and technically easy closure method that enables
serosa-serosa inverted closure, as with surgical sutures. Here, we describe a novel
dual slim grasping forceps-assisted over-the-scope (OTS) clip closure under dual-channel
endoscopy in gastric EFTR. With this technique, the difficult maneuvers and high cost
associated with Twin Grasper forceps (Ovesco Endoscopy GmbH, Tübingen, Germany) can
be overcome.
A 65-year-old man presented with a gastrointestinal stromal tumor in the upper stomach.
After standard EFTR, a full-thickness defect measuring 15 mm in diameter remained
([Fig. 1 a ]). After obtaining written informed consent, the defect was closed according to the
following description ([Fig. 2 ], [Video 1 ]). The equipment comprised two grasping forceps (TechGrasper; Micro-Tech, Nanjing,
China) (cost US$24) instead of the Twin Grasper forceps (cost US$ 694). TechGrasper
forceps have two advantages: the slim shaft (1.8 mm outer diameter) is less likely
to interfere with suction power before firing the OTS clip, and the deep spike provides
strength when grasping the seromuscular layer. The TechGrasper forceps were inserted
into the gastroscope’s dual channels (GIF-2TQ260M; Olympus, Tokyo, Japan) mounted
with an OTS clip (gc type, 10 mm; Ovesco Endoscopy). One forceps was used to grasp
the seromuscular layer on one side of the defect, and the other was opened to grasp
the contralateral seromuscular layer ([Fig. 1 b ]). Both grasping forceps were pulled into the OTS clip cap under sufficient suction,
and an OTS clip was deployed ([Fig. 1 c ]). The seromuscular layer was inverted in tight apposition. The closure time was
30 minutes. Laparoscopic observation revealed no air leakage and the inverted full-thickness
closure was confirmed ([Fig. 3 ]).
Fig. 1 Endoscopic images. a After standard full-thickness resection, a defect measuring 15 mm in diameter remained.
b Two grasping forceps were inserted into the gastroscope’s dual channels mounted with
an over-the-scope (OTS) clip, and the seromuscular layers on both sides of the defect
were grasped. c The two grasping forceps were pulled into the OTS clip cap under sufficient suction,
and the OTS clip was deployed.
Fig. 2 Schema showing over-the-scope clip closure using dual grasping forceps (TechGrasper;
Micro-Tech, Nanjing, China). Source: Davinchi Medical Illustration Office.
Video 1 Over-the-scope clip closure using the dual TechGrasper (Micro-Tech, Nanjing, China)
after endoscopic full-thickness resection.
Fig. 3 Laparoscopic view showing that the seromuscular layer was inverted in tight apposition.
Yellow arrows show the closure line.
Dual TechGrasper-assisted OTS clip closure is cost-effective and a useful option for
facilitating inverted full-thickness closure.
Endoscopy_UCTN_Code_TTT_1AO_2AG
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Correction: Efficacy and cost-effectiveness of a novel dual grasping forceps-assisted
over-the-scope clip inverted closure after gastric endoscopic full-thickness resection
