A modified approach for closing endoscopic submucosal dissection defects using clip with line pulley securing technique and endoloop

Introduction:Endoscopic submucosal dissection (ESD) has been developed as a minimally invasive treatment.However, in some instances, closure of post ESD defects may be necessary in patients with high risk of delayed bleeding, or in patients with deep muscle injury or intraprocedural perforation.While hemostatic clips may be used to close small defects, closure of larger defects is challenging.Purse-string closure method is suitable for larger defects but may require double channel scope, scope replacement, and poses alignment complexities 1).Suturing devices are costly and cumbersome 2) 3).Technique selection should take into account defect size, procedural ease, equipment accessibility, and cost-