Line-assisted complete closure of large gastric mucosal defects by use of multiple clip-and-line technique

Perforation is a serious adverse event of endoscopic resection. Although they are usually managed by endoscopic clip closure, 3% to 6% of perforations during gastric endoscopic resection cannot be completely closed and therefore require emergency surgery. We developed the line-assisted complete closure (LACC) technique to close large colorectal mucosal defects after endoscopic submucosal dissection (ESD) and have applied this technique to large mucosal defects after gastric ESD. A 40-mm mucosal defect resulting from gastric ESD was closed by LACC using a multiple clip-and-line technique (Figs. 1A and B; Video 1, available online at www.VideoGIE.org).