Endoscopic mucosa–submucosal clip closure method

It is desirable to perform a prophylactic closure using endoclips in patients who are at high risk of delayed bleeding or perforation after endoscopic resection [ 1 ]. A mucosal defect after endoscopic mucosal resection can be closed with sequential endoclips as if zipping up the mucosal edges. However, it is difficult to close a large mucosal defect after endoscopic submucosal dissection (ESD) using only conventional endoclips. Several methods have been reported, such as the “slip knot clip suturing method” [ 2 ] and the “endoscopic hand-suturing” technique [ 3 ]. However, these endoscopic closure methods can be difficult, and require a string or special device, which is not always available and takes time to apply. This report describes a simpler closure method using conventional endoclips. In the “mucosa–submucosa clip closure method”, endoclips (EZ Clip, HX-610-090 L long-type; Olympus, Tokyo, Japan) are placed at the edge of the mucosal defect after colorectal ESD. Each arm of the endoclip grips the mucosa and submucosa, respectively. The direction in which the endoclip grips is parallel to the short axis of the defect. Several endoclips are applied in this way, and the mucosal defect is significantly reduced in size. Then, additional endoclips can be applied to both sides of the mucosal defect. Several endoclips are required to achieve complete closure ([ Video 1 ]). Video 1 Mucosa–submucosa clip closure method. a A mucosal defect after colonic endoscopic submucosal dissection. b Endoclips are placed at the edge of the mucosal defect. Each arm of the endoclip hooks mucosa and submucosa, respectively. The direction in which the endoclip grips is parallel to the short axis of the defect. c Several endoclips are applied to the mucosal edge in the same way, bringing the mucosal edges close to each other and enabling application of clips to both sides of the mucosa. d Additional endoclips are placed to achieve complete closure. Quality: mobile 360 480 720 Download This method is simple, and greatly facilitates complete closure of a large mucosal defect simply by applying conventional endoclips. Endoscopy_UCTN_Code_TTT_1AQ_2AC Endoscopy E-Videos https://eref.thieme.de/e-videos Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. This section has its own submission website at https://mc.manuscriptcentral.com/e-videos