Ring-string traction for successful endoscopic clip closure to treat delayed perforation of the ulcer bed after colorectal endoscopic submucosal dissection

Endoscopic closure of delayed perforations after colorectal endoscopic submucosal dissection (ESD) is challenging due to the fragility of the ulcer bed and the stiffness of the surrounding tissue [1] [2] [3] [4]. The case presented here illustrates closure of an ulcer bed with delayed perforation after ESD by endoscopic mucosa-to-mucosa closure using a ring-string traction ([Fig. 1]; [Video 1]).