A novel gastric defect closure method using lines and reopenable clips with the through-the-scope tying technique

Gastric endoscopic submucosal dissection (ESD) defect closure is a difficult procedure in terms of achieving complete closure. Recently, a useful method for closing defects using a line and needle was reported [1]; however, the endoscope must be withdrawn for ligation of the lines. Therefore, we have devised a new closure method, the "through-the-scope tying technique" (TTST), in which the lines are tied by hand outside of the body and can be ligated through the endoscope accessory channel.