Complete closure after colorectal endoscopic submucosal dissection with a re-openable clip with a sharp claw

Background and Aims: The MANTIS Closure Device (MCD: Boston Scientific, USA), a reopenable clip with a sharp claw, is a closure device used after endoscopic submucosal dissection (ESD). We aimed to evaluate the effectiveness of MCD for fast and complete closure after colorectal ESD. Methods: Cases that underwent closure with MCD after ESD of colorectal lesions 20-60 mm between April 2023 and January 2024 were reviewed. The primary endpoint was the complete closure of the ESD defect with MCD. Secondary endpoints included closure time, delayed bleeding (DB), perforation (DP), and post-ESD coagulation syndrome (PECS). The usage of MCD involved 1. grasping the anal-side mucosa around the defect, 2. pushing it toward the oral-side mucosa around the defect and deploying it, 3. adding several re-openable clips (Sure clip, Micro-Tech, China) for complete closure. Results: Sixty-one cases with MCD were analyzed. The mean tumor size was 32.3±9.2 mm. The complete closure rate was 98.4% and closure time (mean±standard deviation: SD) was 6.9±2.6 mins. The number of MCD and Sure clip (mean±SD) were 1.0±0.1 and 4.7±1.4. The rates of DP/DB/PECS were 0%, 0%, and 9.8%, respectively. Conclusion: Fast and complete closure after colorectal ESD was successfully achieved using MCD.