Line‐assisted complete closure of a large colorectal mucosal defect after endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) can be used to remove large superficial colorectal tumors. However, this may result in large mucosal defects associated with potential adverse events such as bleeding, perforation, and electrocoagulation syndrome.1 Although complete closure of such mucosal defects has been reported to reduce complications after colorectal endoscopic resection, it is often impossible to close large defects completely.2 We therefore developed a novel closure technique using a clip and line, referred to as line-assisted complete closure (LACC). We carried out LACC of a 35-mm mucosal defect after ESD in the ascending colon (Video S1). A long nylon line was tied to the arm of an endoclip (HX-610-090; Olympus, Tokyo, Japan) mounted on an applicator (HX-110LR; Olympus). The endoclip should not be opened fully at this point. The endoclip was then retracted into the applicator and inserted into the accessory channel. The endoclip and line was then placed on the normal mucosa, 5 mm from the proximal margin of the wound (Fig. 1a). Another endoclip without a line was then inserted into the accessory channel and anchored to the other side of the normal mucosa by the second clip. Both clips were gathered by gently pulling the line (Fig. 1b). Further additional endoclips with/without a line were placed to achieve complete closure (Fig. 1c). Finally, the line tied to the endoclip was cut using scissor forceps (FS-3 L-1; Olympus) (Fig. 1d). We subsequently managed to close an even larger mucosal defect (45 mm) using this method (Fig. 2). Although previously reported techniques have required special devices,3, 4 LACC requires the use of normal endoclips and a nylon line only. Slipknot clip suturing method is another option for closing large mucosal defects;5 however, we consider LACC to be simpler and easier to carry out. VIDEO S1 Line-assisted complete closure technique for a large mucosal defect after endoscopic resection in the ascending colon. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.