Feasibility of endoscopic mucosa-submucosa clip closure method (with video)

Abstract

Background and study aims We developed a new endoscopic closure technique using just conventional endoclips. The feasibility of endoscopic mucosa-submucosa clip closure method was evaluated in this clinical pilot study.

Patients and methods This study involved consecutive 25 patients who underwent colorectal endoscopic submucosal dissection. Endoclips were placed at the edge of the mucosal defect. Each arm of the endoclip gripped the mucosa and submucosa, respectively. The direction in which the endoclip grips were placed was parallel to the short axis of the defect. Several endoclips were applied in this way. As a result, the mucosal defect was significantly reduced in size. Additional clips were placed to achieve complete closure.

Results Mean size of resected specimen was 31.2 ± 11 mm. The success rate was 96 % (24/25). Mean procedure time was 9.6 ± 4.4 minutes. Mean number of endoclips was 9.3 ± 3.7. No complications were observed in any of the patients after the procedure.

Conclusion Endoscopic mucosa-submucosa clip closure method could close mucosal defect of size around 2 – 4 cm completely using just conventional endoclips, and it seems easy, simple and low cost.

• References

• 1 Kinoshita S, Uraoka T, Nishizawa T. et al. The role of colorectal endoscopic submucosal dissection in patients with ulcerative colitis. Gastrointest Endosc 2018; 87: 1079-1084
• 2 Uraoka T, Parra-Blanco A, Yahagi N. Colorectal endoscopic submucosal dissection in Japan and Western countries. Dig Endosc 2012; 24 (Suppl. 01) 80-83
• 3 Nishizawa T, Uraoka T, Suzuki H. et al. Control of the treatment device for endoscopy by the left hand: two-fingers method. Gastrointest Endosc 2014; 80: 1206-1207
• 4 Nishizawa T, Uraoka T, Suzuki H. et al. Control of tip deflection by right pinkie shaft grip: right pinkie maneuver. Gastrointest Endosc 2014; 80: 1208
• 5 Saito Y, Uraoka T, Yamaguchi Y. et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72: 1217-1225
• 6 Arezzo A, Passera R, Marchese N. et al. Systematic review and meta-analysis of endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal lesions. United European Gastroenterol J 2016; 4: 18-29
• 7 Kobayashi N, Yoshitake N, Hirahara Y. et al. Matched case-control study comparing endoscopic submucosal dissection and endoscopic mucosal resection for colorectal tumors. J Gastroenterol Hepatol 2012; 27: 728-733
• 8 Fujishiro M, Yahagi N, Kakushima N. et al. Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 2007; 5: 678-683 ; quiz 45
• 9 Isomoto H, Nishiyama H, Yamaguchi N. et al. Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 2009; 41: 679-683
• 10 Ono S, Fujishiro M, Yoshida N. et al. Thienopyridine derivatives as risk factors for bleeding following high risk endoscopic treatments: Safe Treatment on Antiplatelets (STRAP) study. Endoscopy 2015; 47: 632-637
• 11 Akimoto T, Goto O, Nishizawa T. et al. Endoscopic closure after intraluminal surgery. Dig Endosc 2017; 29: 547-558
• 12 Liaquat H, Rohn E, Rex DK. Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions. Gastrointest Endosc 2013; 77: 401-407
• 13 Otake Y, Saito Y, Sakamoto T. et al. New closure technique for large mucosal defects after endoscopic submucosal dissection of colorectal tumors (with video). Gastrointest Endosc 2012; 75: 663-667
• 14 Matsuda T, Fujii T, Emura F. et al. Complete closure of a large defect after EMR of a lateral spreading colorectal tumor when using a two-channel colonoscope. Gastrointest Endosc 2004; 60: 836-838
• 15 Nishizawa T, Uraoka T, Suzuki H. et al. New endoscopic suturing method: slip knot clip suturing. Gastrointest Endosc 2015; 82: 570-571
• 16 Nishizawa T, Uraoka T, Sagara S. et al. Endoscopic slipknot clip suturing method: an ex vivo feasibility study (with video). Gastrointest Endosc 2016; 83: 447-450
• 17 Nishizawa T, Ochiai Y, Uraoka T. et al. Endoscopic slip-knot clip suturing method: prospective pilot study (with video). Gastrointest Endosc 2017; 85: 433-437
• 18 Yahagi N, Nishizawa T, Akimoto T. et al. New endoscopic suturing method: string clip suturing method. Gastrointest Endosc 2016; 84: 1064-1065
• 19 Nishizawa T, Akimoto T, Uraoka T. et al. Endoscopic string clip suturing method: a prospective pilot study (with video). Gastrointest Endosc 2018; 87: 1074-1078
• 20 Osada T, Sakamoto N, Ritsuno H. et al. Process of wound healing of large mucosal defect areas that were sutured by using a loop clip-assisted closure technique after endoscopic submucosal dissection of a colorectal tumor. Gastrointest Endosc 2013; 78: 793-798
• 21 Banno S, Nishizawa T, Kinoshita S. et al. Endoscopic mucosa-submucosal clip closure method. Endoscopy 2017; 49: E307-E308
• 22 Nishizawa T, Suzuki H, Goto O. et al. Effect of prophylactic clipping in colorectal endoscopic resection: A meta-analysis of randomized controlled studies. United European Gastroenterol J 2017; 5: 859-867
• 23 Wang J, Zhao L, Wang X. et al. A novel endoloop system for closure of colonic mucosal defects through a single-channel colonoscope. Endoscopy 2017; 49: 803-807
• 24 Kantsevoy SV, Bitner M, Mitrakov AA. et al. Endoscopic suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible, fast, and eliminates the need for hospitalization (with videos). Gastrointest Endosc 2014; 79: 503-507
• 25 Hochberger J, Wedi E, Tchoumak I. et al. Over-the-scope clip placement and endosponge insertion for prevention of pancreatic enzyme-induced duodenal damage after large duodenal endoscopic resection. Endoscopy 2016; 48: E401-E402
• 26 von Renteln D, Schmidt A, Vassiliou MC. et al. Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study. Endoscopy 2009; 41: 481-486