Clinical utility of a novel anchor pronged clip for mucosal defect closure after colorectal endoscopic submucosal dissection (with video)

Abstract

Background and study aims The MANTIS Clip (Boston Scientific) is a novel anchor pronged clip designed to enhance tissue grasping and facilitate the closure of defects in the gastrointestinal tract. This study evaluates the feasibility and effectiveness of the MANTIS Clip for closing mucosal defects following colorectal endoscopic submucosal dissection (C-ESD).

Patients and methods A retrospective single-center study was conducted on patients who underwent C-ESD with MANTIS Clip closure from May 2023 to April 2024. The primary outcome measured was the complete closure success rate. Secondary outcomes included defect size, sustained closure rate, closure time, number of clips used, adverse events (AEs), and hospital stay duration.

Results The MANTIS Clip was used in 52 cases. The complete closure rate was 98.1% (51/52), with a sustained closure rate of 96.1% (49/51). The median closed defect size was 32 mm, with the largest being 62 mm. The median closure time was 8 minutes. Typically, one MANTIS Clip per defect was used, with only one lesion requiring two clips. The median number of additional clips used was seven. AEs included one case of bleeding (1.9%) and one case of post-ESD coagulation syndrome (1.9%), both managed without extending hospital stays. The median C-reactive protein level on the first day post-ESD was 0.35 mg/dL and the median hospital stay was 5 days.

Conclusions The MANTIS Clip is effective and practical for mucosal defect closure post-C-ESD, demonstrating high success and sustained closure rates with minimal complications. Future multicenter randomized trials are needed to further assess its efficacy and safety.

Keywords

Endoscopy Lower GI Tract - Colorectal cancer - Endoscopic resection (polypectomy, ESD, EMRc, ...)

Publikationsverlauf

Eingereicht: 31. Juli 2024

Angenommen nach Revision: 03. September 2024

Accepted Manuscript online:
09. September 2024

Artikel online veröffentlicht:
10. Oktober 2024

• References

• 1 Gotoda T, Kondo H, Ono H. et al. A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc 1999; 50: 560-563
• 2 Fujishiro M, Yahagi N, Kakushima N. et al. Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2007; 5: 678-683
• 3 Saito Y, Uraoka T, Matsuda T. et al. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc 2007; 66: 966-973
• 4 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
• 5 Fuccio L, Hassan C, Ponchon T. et al. Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 74-86.e17
• 6 Hirasawa K, Sato C, Makazu M. et al. Coagulation syndrome: Delayed perforation after colorectal endoscopic treatments. World J Gastrointest Endosc 2015; 7: 1055-1061
• 7 Zhang QS, Han B, Xu JH. et al. Clip closure of defect after endoscopic resection in patients with larger colorectal tumors decreased the adverse events. Gastrointest Endosc 2015; 82: 904-909
• 8 Pohl H, Grimm IS, Moyer MT. et al. Clip closure prevents bleeding after endoscopic resection of large colon polyps in a randomized trial. Gastroenterology 2019; 157: 977-984.e973
• 9 Liu M, Zhang Y, Wang Y. et al. Effect of prophylactic closure on adverse events after colorectal endoscopic submucosal dissection: A meta-analysis. J Gastroenterol Hepatol 2020; 35: 1869-1877
• 10 Omori J, Goto O, Habu T. et al. Prophylactic clip closure for mucosal defects is associated with reduced adverse events after colorectal endoscopic submucosal dissection: a propensity-score matching analysis. BMC Gastroenterol 2022; 22: 139
• 11 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
• 12 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
• 13 Akimoto T, Goto O, Sasaki M. et al. "Hold-and-drag" closure technique using repositionable clips for large mucosal defects after colonic endoscopic submucosal dissection. Endosc Int Open 2016; 4: E1068-E1072
• 14 Akimoto T, Goto O, Nishizawa T. et al. Endoscopic closure after intraluminal surgery. Dig Endosc 2017; 29: 547-558
• 15 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
• 16 Nomura T, Matsuzaki I, Sugimoto S. et al. Clip-on-clip closure method for a mucosal defect after colorectal endoscopic submucosal dissection: a prospective feasibility study. Surg Endosc 2020; 34: 1412-1416
• 17 Abe S, Saito Y, Tanaka Y. et al. A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study. Endoscopy 2020; 52: 780-785
• 18 Inoue H, Tanabe M, Shimamura Y. et al. A novel endoscopic purse-string suture technique, "loop 9", for gastrointestinal defect closure: a pilot study. Endoscopy 2022; 54: 158-162
• 19 Masunaga T, Kato M, Sasaki M. et al. Modified double-layered suturing for a mucosal defect after colorectal endoscopic submucosal dissection (Origami method) (with video). Gastrointest Endosc 2023; 97: 962-969
• 20 Yamasaki Y, Harada K, Oka S. et al. Feasibility of underwater clip closure for large mucosal defects after colorectal endoscopic submucosal dissection. Digestion 2019; 99: 327-332
• 21 Mizutani H, Tsuji Y, Hisada H. et al. Successful closure of gastric wall defect after endoscopic full-thickness resection using novel anchor pronged clips: a case report. Endoscopy 2023; 55: E1234-E1235
• 22 Nishiyama N, Matsui T, Nakatani K. et al. Novel strategy of hold-and-drag clip closure with mantis-like claw for post-gastric endoscopic submucosal dissection defect of <30 mm. Endoscopy 2023; 55: E1244-E1245
• 23 Kitagawa D, Shichijo S, Li JW. et al. Use of a novel re-openable endoclip for the closure of a large mucosal defect after endoscopic submucosal dissection. Endoscopy 2023; 55: E883-E884
• 24 Kubota Y, Nishiyama R, Sasaki M. et al. Fixation of an esophageal stent using a novel re-openable endoclip for a tracheoesophageal fistula. DEN Open 2024; 4: e342
• 25 Motomura D, Toyonaga T, Takayama H. et al. Endoscopic double-layered suturing: an updated technique for clip closure of large mucosal defects after endoscopic submucosal dissection. VideoGIE 2024; 9: 95-98
• 26 Tanaka S, Kashida H, Saito Y. et al. Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2020; 32: 219-239
• 27 Sakamoto H, Hayashi Y, Miura Y. et al. Pocket-creation method facilitates endoscopic submucosal dissection of colorectal laterally spreading tumors, non-granular type. Endosc Int Open 2017; 5: E123-E129
• 28 Abe M, Hayashi T, Kudo SE. Bridge formation method in colorectal endoscopic submucosal dissection. Dig Endosc 2023; 35: e11-e12
• 29 Yahagi N, Nishizawa T, Sasaki M. et al. Water pressure method for duodenal endoscopic submucosal dissection. Endoscopy 2017; 49: E227-E228
• 30 Kato M, Uedo N, Hokimoto S. et al. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment: 2017 appendix on anticoagulants including direct oral anticoagulants. Dig Endosc 2018; 30: 433-440
• 31 Yamashina T, Takeuchi Y, Uedo N. et al. Features of electrocoagulation syndrome after endoscopic submucosal dissection for colorectal neoplasm. J Gastroenterol Hepatol 2016; 31: 615-620
• 32 Libânio D, Pimentel-Nunes P, Bastiaansen B. et al. Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2023; 55: 361-389