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DOI: 10.1055/a-2489-8253
Gastric defect closure with reopenable clip over-the-line method and dual-action tissue clip for 3-point fixation
After endoscopic submucosal dissection (ESD) of the stomach, defect closure is difficult because a submucosal dead space (SDS) is created by the thick muscle layer and mucosa, even with the use of ordinary clips alone [1]. Therefore, we devised the reopenable clip over-the-line method (ROLM), which enables the amount of SDS to be reduced [2] [3] [4]. However, this method is time consuming. Therefore, we further devised a method that uses ROLM and the dual-action tissue (DAT) clip for 3-point fixation for defect closure ([Fig. 1], [Video 1]).


Here, we describe the case of a 68-year-old man with early cancer in the posterior wall of the middle gastric body ([Fig. 2]). A 40-mm mucosal defect occurred after ESD, which was closed using ROLM with 3-point fixation. First, the defect edge was grasped using the first tooth of the DAT clip. Then, the contralateral defect edge, and if possible, the submucosal layer above the muscle layer in the middle of the defect were grasped using the second tooth of the clip. After confirming that the edges of the defect on both sides were fixed, a clip was placed. The first clip, with a line for ROLM, was then placed on the most distal defect edge. The line was threaded through the holes in the reopenable-clip teeth. Subsequently, a clip with a line threaded through one tooth was placed at the contralateral edge of the defect. The defect edges were already in close proximity; thus, the time required for additional clips was reduced.


ROLM allows the placement of clips without embedding the through-the-scope DAT clip on the defect side. The defect was completely closed by repeatedly placing clips on the defect edge on one side. A total of 22 reopenable clips were used, and the time required for ROLM was only 12 minutes.
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Conflict of Interest
The authors declare that they have no conflict of interest.
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References
- 1 Nomura T, Sugimoto S, Temma T. et al. Suturing techniques with endoscopic clips and special devices after endoscopic resection. Dig Endosc 2023; 35: 287-301
- 2 Nomura T, Sugimoto S, Temma T. et al. Reopenable clip over-the-line method with muscle layer grasping clips for large duodenal post-endoscopic submucosal dissection defects. Endoscopy 2022; 54: E782-E783
- 3 Nomura T, Sugimoto S, Temma T. et al. Reopenable clip-over-the-line method for closing large mucosal defects following gastric endoscopic submucosal dissection: prospective feasibility study. Dig Endosc 2023; 35: 505-511
- 4 Nomura T, Sugimoto S, Temma T. et al. Reopenable clip-over-the-line method for closing large mucosal defects following colorectal endoscopic submucosal dissection: a feasibility study. Endosc Int Open 2023; 11: E697-E702
Correspondence
Publication History
Article published online:
10 December 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Georg Thieme Verlag KG
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References
- 1 Nomura T, Sugimoto S, Temma T. et al. Suturing techniques with endoscopic clips and special devices after endoscopic resection. Dig Endosc 2023; 35: 287-301
- 2 Nomura T, Sugimoto S, Temma T. et al. Reopenable clip over-the-line method with muscle layer grasping clips for large duodenal post-endoscopic submucosal dissection defects. Endoscopy 2022; 54: E782-E783
- 3 Nomura T, Sugimoto S, Temma T. et al. Reopenable clip-over-the-line method for closing large mucosal defects following gastric endoscopic submucosal dissection: prospective feasibility study. Dig Endosc 2023; 35: 505-511
- 4 Nomura T, Sugimoto S, Temma T. et al. Reopenable clip-over-the-line method for closing large mucosal defects following colorectal endoscopic submucosal dissection: a feasibility study. Endosc Int Open 2023; 11: E697-E702



