Successful closure of gastric wall defect after endoscopic full-thickness resection using novel anchor pronged clips: a case report

We present the case of a 52-year-old woman who underwent endoscopic full-thickness resection (EFTR) with one port placement for a 20-mm large gastric submucosal tumor originating from the muscularis propria layer ([Fig. 1]).

Fig. 1 Imaging for the submucosal tumor at the lesser curvature of the gastric angle, originating from the muscularis propria layer. a Endoscopic image. b Endoscopic ultrasound image.

EFTR was initiated with a mucosal incision around the entire circumference of the lesion using a DualKnife J (KD-655Q; Olympus, Tokyo, Japan), followed by a full-thickness resection using an ITknife2 (KD-611L; Olympus) in combination with traction provided by a multi-loop traction device (Boston Scientific, Marlborough, Massachusetts, USA) [1].

After resection, we employed novel anchor pronged clips (MANTIS Clip; Boston Scientific) to close the large transmural defect ([Fig. 2]). The MANTIS Clip was used to grasp one edge of the defect and pull it toward the opposite edge by endoscope manipulation. The anchor prong at the tip of the clip arm prevented the pulled tissue from slipping out when the clip was reopened, allowing it to close over the contralateral edge. We applied three MANTIS Clips for initial closure and reinforced this with re-openable clips to achieve complete closure ([Fig. 3], [Video 1]). No postoperative complications were observed, and histopathological examination confirmed the diagnosis of schwannoma with R0 resection.

Fig. 2 Closure using novel anchor pronged clips (MANTIS Clips; Boston Scientific, Marlborough, Massachusetts, USA). a–c The MANTIS Clip is used to grasp one edge of the defect and pull it toward the opposite edge. d–f After tissue approximation, the clip is reopened and then closed over the opposite edge before complete deployment.

Fig. 3 Closure of the defect. a The large defect after endoscopic full-thickness resection was initially closed by three MANTIS Clips (Boston Scientific, Marlborough, Massachusetts, USA). b Complete closure was achieved by reinforcement with re-openable clips.

Closure of a gastric wall defect after endoscopic full-thickness resection using novel anchor pronged clips.Video 1

While reports exist on the endoloop-assisted closure method [2] and the over-the-scope clip system (OTSC; Ovesco Endoscopy AG, Tübingen, Germany) [3] for defect closure after EFTR, these methods require a dual-channel endoscope, reinsertion of the endoscope, or some special manipulation. OverStitch (Apollo Endosurgery, Austin, Texas, USA) is expected to provide robust full-thickness sutures, but its use requires technical training [4]. The MANTIS Clip, which functions similarly to a conventional through-the-scope clip, offers simple and effective closure with robust grasping force and tissue apposition capability. This novel closure device can be a viable and effective option for defect closure after EFTR.

Endoscopy_UCTN_Code_TTT_1AO_2AI

Publikationsverlauf

Artikel online veröffentlicht:
11. Dezember 2023

• References

• 1 Jinushi R, Tashima T, Terada R. et al. Effectiveness of a multi-loop traction device for colorectal endoscopic submucosal dissection performed by trainees: a pilot study. Sci Rep 2022; 12: 10197 DOI: 10.1038/s41598-022-14407-3. (PMID: 35715564)
• 2 Shi Q, Chen T, Zhong YS. et al. Complete closure of large gastric defects after endoscopic full-thickness resection, using endoloop and metallic clip interrupted suture. Endoscopy 2013; 45: 329-334 DOI: 10.1055/s-0032-1326214. (PMID: 23468195)
• 3 Guo J, Liu Z, Sun S. et al. Endoscopic full-thickness resection with defect closure using an over-the-scope clip for gastric subepithelial tumors originating from the muscularis propria. Surg Endosc 2015; 29: 3356-3362
• 4 Pawlak KM, Raiter A, Kozłowska-Petriczko K. et al. Optimal endoscopic resection technique for selected gastric GISTs. The endoscopic suturing system combined with ESD – a new alternative?. J Clin Med 2020; 9: 1776