A novel reopenable clip with sharp claw for complete closure of mucosal defects after colorectal endoscopic submucosal dissection

Abstract

Background

The MANTIS Closure Device (MCD; Boston Scientific, Marlborough, Massachusetts, USA) is a reopenable clip with a sharp claw used for closure after endoscopic submucosal dissection (ESD). We evaluated the effectiveness of the MCD for fast and complete closure after colorectal ESD.

Methods

Cases involving closure with the MCD after ESD of 20–60-mm colorectal lesions between April 2023 and January 2024 were reviewed. The primary end point was complete closure of the ESD defect with the MCD. Secondary end points included closure time, delayed bleeding, delayed perforation, and post-ESD coagulation syndrome (PECS). MCD application involved: 1) grasping the mucosa on the anal-side of the defect; 2) pushing the clip toward the oral-side mucosa and deploying it; 3) adding other reopenable clips for complete closure.

Results

61 cases involving MCD were analyzed. Mean tumor size was 32.3 (SD 9.2) mm. Complete closure rate was 98.4% and mean closure time was 6.9 (SD 2.6) minutes. The mean number of MCDs and other clips used was 1.0 (SD 0.1) and 4.7 (SD 1.4), respectively. Rates of delayed bleeding, delayed perforation, and PECS were 0%, 0%, and 9.8%, respectively.

Conclusion

Fast and complete closure after colorectal ESD was successfully achieved using the MCD.

Publication History

Received: 21 May 2024

Accepted after revision: 25 September 2024

Accepted Manuscript online:
25 September 2024

Article published online:
06 November 2024

• References

• 1 Tanaka S, Kashida H, Saito Y. et al. Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2020; 32: 219-239
• 2 Draganov PV, Wang AY, Othman MO. et al. AGA Institute Clinical Practice Update: endoscopic submucosal dissection in the United States. Clin Gastroenterol Hepatol 2019; 17: 16-25.e1
• 3 Pimentel-Nunes P, Libânio D, Bastiaansen BAJ. et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – update 2022. Endoscopy 2022; 54: 591-622
• 4 Fuccio L, Hassan C, Ponchon T. et al. Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 74-86.e17
• 5 Kobara H, Tada N, Fujihara S. et al. Clinical and technical outcomes of endoscopic closure of postendoscopic submucosal dissection defects: literature review over one decade. Dig Endosc 2023; 35: 216-231
• 6 Boda K, Oka S, Tanaka S. et al. Clinical outcomes of endoscopic submucosal dissection for colorectal tumors: a large multicenter retrospective study from the Hiroshima GI Endoscopy Research Group. Gastrointest Endosc 2018; 87: 714-722
• 7 Shichijo S, Takeuchi Y, Shimodate Y. et al. Performance of perioperative antibiotics against post-endoscopic submucosal dissection coagulation syndrome: a multicenter randomized controlled trial. Gastrointest Endosc 2022; 95: 349-359
• 8 Furukawa K, Furune S, Hirose T. et al. Suturing of a mucosal defect after gastric endoscopic submucosal dissection using a combination of an anchor pronged clip and conventional clips. Rev Esp Enferm Dig 2023; 2023
• 9 WHO Classification of Tumours Editorial Board. Digestive System Tumours. Lyon:: International Agency for Research on Cancer (IARC); 2019
• 10 Akimoto T, Goto O, Sasaki M. et al. “Hold-and-drag” closure technique using repositionable clips for large mucosal defects after colonic endoscopic submucosal dissection. Endosc Int Open 2016; 4: E1068-1072
• 11 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: E697-702
• 12 Otake Y, Saito Y, Sakamoto T. et al. New closure technique for large mucosal defects after endoscopic submucosal dissection of colorectal tumors (with video). Gastrointest Endosc 2012; 75: 663-667
• 13 Yamasaki Y, Harada K, Oka S. et al. Feasibility of underwater clip closure for large mucosal defects after colorectal endoscopic submucosal dissection. Digestion 2019; 99: 327-332
• 14 Masunaga T, Kato M, Sasaki M. et al. Modified double-layered suturing for a mucosal defect after colorectal endoscopic submucosal dissection (Origami method) (with video). Gastrointest Endosc 2023; 97: 962-969
• 15 Yamasaki Y, Takeuchi Y, Iwatsubo T. et al. Line-assisted complete closure for a large mucosal defect after colorectal endoscopic submucosal dissection decreased postelectrocoagulation syndrome. Dig Endosc 2018; 30: 633-641
• 16 Dohi O, Yoshida N, Naito Y. et al. Efficacy and safety of endoscopic submucosal dissection using a scissors-type knife with prophylactic over-the-scope clip closure for superficial non-ampullary duodenal epithelial tumors. Dig Endosc 2020; 32: 904-913
• 17 Kantsevoy SV, Bitner M, Mitrakov AA. et al. Endoscopic suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible, fast, and eliminates the need for hospitalization (with videos). Gastrointest Endosc 2014; 79: 503-507
• 18 Higuchi K, Goto O, Koizumi E. et al. Correction: Potential for expanded application of endoscopic hand suturing: a pilot study of 15 cases. Endosc Int Open 2024; 12: C8
• 19 Albouys J, Montri Pina S, Boukechiche S. et al. Risk of delayed bleeding after colorectal endoscopic submucosal dissection: the Limoges Bleeding Score. Endoscopy 2024; 56: 110-118
• 20 Yoshida N, Hayashi Y, Togo D. et al. An analysis of delayed bleeding in cases of colorectal endoscopic submucosal dissection due to types of direct oral anticoagulants in Japan. Clin Gastroenterol Hepatol 2024; 22: 271-282.e3