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DOI: 10.1055/a-1346-8991
Clip-line closure with the reopenable clip over line method for a large mucosal defect after gastric endoscopic submucosal dissection
![](https://www.thieme-connect.de/media/endoscopy/202201/lookinside/thumbnails/2234_10-1055-a-1346-8991-1.jpg)
Mucosal defects that occur following large gastric endoscopic submucosal dissection (ESD) are a cause of postoperative bleeding [1] [2] [3]. A standard method for large mucosal defect closure without dead space between the normal mucosa and mucosal defect has not yet been established. We invented clip-line closure with the reopenable clip over line method (ROLM) for complete closure of the mucosal defect left after gastric ESD.
In clip-line closure using ROLM, only reopenable clips (SureClip; 8 or 16 mm; MC Medical, Tokyo, Japan) and a line (0.23 mm nylon line) are used. First, the line is tied to one tooth of a reopenable clip, which is then inserted into the accessory channel without the endoscope being withdrawn ([Fig. 1]; [Video 1]). The clip is then positioned so that it grips the margin of the mucosal defect. Next, the end of the line exiting the accessory channel of the endoscope is passed through the hole in one tooth of a second reopenable clip, and this reopenable clip is inserted into the endoscope (the ROLM). The second clip is placed on the opposite side of the defect, with the muscular layer of the mucosal defect being grasped by the tooth of the reopenable clip through which the line has been passed. The teeth of the reopenable clips through which the line passes are therefore continuously fixed by the line, preventing the clips from being buried into the side of the muscle layer. Repeating ROLM gradually closes the mucosal defect from the anal to the oral side. [Video 1] shows an in vitro model and a patient example of mucosal defect closure post-gastric ESD using clip-line closure with ROLM ([Fig. 2]).
![](https://www.thieme-connect.de/media/endoscopy/202201/thumbnails/10-1055-a-1346-8991-i2234ev1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Video 1 Video showing an in vitro model of clip-line closure with the reopenable clip over line method (ROLM) and the performance of clip-line closure with ROLM for a large mucosal defect post-gastric endoscopic submucosal dissection.
Qualität:
![](https://www.thieme-connect.de/media/endoscopy/202201/thumbnails/10-1055-a-1346-8991-i2234ev2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Clip-line closure using ROLM can completely close a large gastric mucosal defect without leaving dead space between the normal mucosa and the mucosal defect.
Endoscopy_UCTN_Code_TTT_1AQ_2AG
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high
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Publikationsverlauf
Artikel online veröffentlicht:
16. Februar 2021
© 2021. Thieme. All rights reserved.
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References
- 1 Takizawa K, Oda I, Gotoda T. et al. Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection – an analysis of risk factors. Endoscopy 2008; 40: 179-183
- 2 Kataoka Y, Tsuji Y, Hirasawa K. et al. Endoscopic tissue shielding to prevent bleeding after endoscopic submucosal dissection: a prospective multicenter randomized controlled trial. Endoscopy 2019; 51: 619-627
- 3 Hatta W, Tsuji Y, Yoshio T. et al. Prediction model of bleeding after endoscopic submucosal dissection for early gastric cancer: BEST-J score. Gut DOI: 10.1136/gutjnl-2019-319926.