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Endoscopy 2023; 55(02): 201
DOI: 10.1055/a-1980-1174
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Commentary

Ana Craciun
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
2   Department of Gastroenterology and Hepatology, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
,
Michael Bourke
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
3   Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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The immersion into the submucosal layer with endoscopic submucosal dissection two decades ago led us to a new era of third-space endoscopy and endoscopic full-thickness resection, whereby many lesions, even with full-thickness muscularis propria involvement, can be safely removed endoscopically. Therefore, endoscopic recognition, characterization, and management of iatrogenic full-thickness mural defects is critical to ensure technical success and safety [1] [2]. The focus has now been increasingly shifting towards developing new devices to close progressively larger defects throughout the gastrointestinal tract. These closure tools, including through-the-scope (TTS) clipping, suture-based, or endoscopic vacuum therapy, need to be adapted to the size and location of the defects. In an experimental study [3] and in this video, Zhang et al. showed the efficacy of novel TTS twin clips (TTS-TCs) for closing wounds ≥ 25 mm, when intertwined with traditional TTS clips, functioning as coadjuvants in reducing submucosal dead space and achieving a firm closure effect. In summary, the TTS-TC holds great promise as a definitive mural closure device as it can be used in a deflated lumen, in situations where access is poor, and promptly without the need for endoscope exchange or reinsertion. Further prospective comparative studies are required to establish efficacy, safety, and cost–effectiveness.



Publication History

Article published online:
26 January 2023

© 2023. Thieme. All rights reserved.

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Refers to:

A novel endoscopic clip for closing a large perforating wound in a patient undergoing endoscopic full-thickness resectionEndoscopy 2022; 54(S 02): E851-E852
DOI: 10.1055/a-1838-4526

 

  • References

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