Successful closure of postoperative defects is essential for endoscopic resection
of early neoplasms. The endoscopic purse-string suture (EPSS) using a double-channel
colonoscope has been shown to be safe and effective. This method involves the interaction
of the endoloop and the metal clips through two separate endoscope channels [1]. However, single-channel colonoscopes are more popular in clinical practice because
of their longer length, more flexible operation, and cheaper price, especially when
used in the right colon. We report on a novel endoloop system that was innovatively
applied via a single-channel endoscope.
A 70-year-old man was referred to our center with a 9-month history of increasing
defecation. Endoscopic examination with biopsy and histopathology revealed a nongranular
type of laterally spreading tumor with moderate atypical hyperplasia in the ileocecal
junction. Endoscopic submucosal dissection was performed for en bloc resection. The
large defect (2.5 × 2.0 cm) was completely closed by EPSS via a single-channel colonoscope
(CF Q260; Olympus, Tokyo, Japan), as follows. As an independent device, the nylon
loop (Loop-30; LeCamp, Changzhou, China) was first delivered and positioned around
the defect. Multiple clips were then applied to fix the endoloop in place. The loop
was tightened by grasping the tail with a hook and pulling backward to close the defect
([Fig. 1], [Video 1]). The entire procedure was completed via the single channel. The closing process
took 8 minutes. The patient was discharged 2 days after the operation without any
adverse events.
Fig. 1 Closure of a colonic defect using a novel endoloop system via a single-channel colonoscope.
a The endoloop. b Endoscopy showed a large colonic defect at the ileocecal junction following endoscopic
submucosal dissection. c A separate endoloop was inserted around the mucosal defect and anchored with clips.
d Several clips were used to anchor the endoloop. e The endoloop was tightened by grasping the endoloop tail with a hook and pulling
backward. f The defect was closed successfully by endoscopic purse-string suture.
Procedure for closing a colonic mucosal defect using an independent endoloop and
clips, via a single-channel colonoscope. The strategy is easy and effective.
Lua et al. [2] described their experience of closing a mucosal defect in the stomach using a single-channel
gastroscope. To our knowledge, the current case is the first report on closure of
a colonic defect via a single-channel colonoscope. With the assistance of an independent
endoloop system, EPSS via a single-channel colonoscope should be feasible, efficient,
and safe for endoscopic defect closure.
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