The running suture with clip and string technique after colonic endoscopic submucosal dissection

A closure technique to prevent bleeding after colorectal endoscopic submucosal dissection (ESD) has previously been reported; Nishizawa et al. reported a string and clip closure technique using the following method [1]. The clip and string can be passed through the instrument channel of a single-channel endoscope and is placed at the distal edge of a large mucosal defect. A second clip is hooked onto the string and placed on the opposite side. Both clips are gathered by pulling the free end of the string, and additional clips are placed to achieve complete closure. This technique has limitations however on the size of the defect that can be completely closed. Therefore, we adapted this method and developed a new closure technique for colorectal ESD ([Video 1]).