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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(08): E947-E954
DOI: 10.1055/a-2362-5617
Original article

Loop9 closure technique for mucosal defects after colorectal endoscopic submucosal dissection (with video)

Mayo Tanabe 
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan (Ringgold ID: RIN378609)
,
Haruhiro Inoue
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan (Ringgold ID: RIN378609)
,
Yuto Shimamura 
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan (Ringgold ID: RIN378609)
,
Akiko Toshimori
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan (Ringgold ID: RIN378609)
,
Marc Julius Hernandez Navarro 
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan (Ringgold ID: RIN378609)
,
Yusuke Fujiyoshi 
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan (Ringgold ID: RIN378609)
,
Mary Raina Angeli Fujiyoshi 
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan (Ringgold ID: RIN378609)
,
Daijiro Shiomi
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan (Ringgold ID: RIN378609)
,
Yumi Kishi
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan (Ringgold ID: RIN378609)
,
Kei Ushikubo
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan (Ringgold ID: RIN378609)
,
Yohei Nishikawa
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan (Ringgold ID: RIN378609)
,
Manabu Onimaru
2   Digestive Diseases Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
,
Takayoshi Ito
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan (Ringgold ID: RIN378609)
,
Naoyuki Uragami
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan (Ringgold ID: RIN378609)
,
Noboru Yokoyama
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan (Ringgold ID: RIN378609)
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Abstract

Background and study aims Mucosal defect closure after colorectal endoscopic submucosal dissection (ESD) has the potential to reduce the occurrence of delayed adverse events (AEs) such as bleeding and perforation. This study aimed to assess the feasibility and effectiveness of the Loop9 method for closing mucosal defects following colorectal ESD.

Patients and methods A retrospective single-center study was conducted using prospectively collected data from May 2020 to March 2023. Loop9 was deployed through a single instrument channel and anchored with clips at the defect site. Closure was accomplished by tightening the loop and deploying additional conventional clips as needed for complete closure. The primary outcome was complete closure rate, with secondary outcomes including the sustained closure rate at 4 to 5 days post-ESD, closed defect size, closure time, number of additional clips, and incidence of delayed AEs.

Results This study included 118 cases. Complete closure was achieved in 96.6% of cases (114/118) with a sustained closure rate of 93.9% (107/114). The median size of the closed mucosal defects was 30 mm (interquartile range [IQR]: 25–38, range: 15–74). The median closure time was 14 minutes (IQR: 11.25–17), and the median number of additional clips deployed was six (IQR: 4–7). Stenosis requiring balloon dilatation was observed in one patient; however, there were no instances of post-ESD bleeding or delayed perforation.

Conclusions The Loop9 method proved feasible and effective for closing mucosal defects following colorectal ESD, achieving high rates of complete and sustained closure.

Keywords

Endoscopy Lower GI Tract - Colorectal cancer - Endoscopic resection (polypectomy, ESD, EMRc, ...) - Quality and logistical aspects - Performance and complications - Polyps / adenomas / ...


Publication History

Received: 08 May 2024

Accepted after revision: 03 July 2024

Accepted Manuscript online:
08 July 2024

Article published online:
08 August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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