STRING-HEMOCLIPS FUSION: AN EFFECTIVE WAY FOR CLOSURE OF A LARGE MUCOSAL DEFECT AFTER EMR/ESD

Aims Large endoscopic submucosal resection (EMR) and dissection (ESD) remain technically challenging and are associated with high risks of severe adverse events (bleeding, delayed perforation); mainly if the patient is taking antithrombotic agents. Complete and strong closure of the post-EMR/ESD mucosal defect seems effective in preventing such events.

Methods We, thus, developed a technique that allows us to strongly suture and completely close a large mucosal defect by a string-hemoclip fusión procedure.

Results A large recto-sigmoid LST-G (approximately 50 mm in size) was resected by piecemeal EMR without complications, in a 79-year-old woman who was taking Clopidogrel up to five days before. A double-channel endoscope with a tip cap was used. First, a string was attached to the hemoclip which is placed in the lateral edge of the residual mucosal defect (at the tail). The second clip hooking the string is placed on the contra-edge. Successive clips are placed similarly in a zig-zag line. The mucosal edges are approximated by pulling the string with a biopsy forceps through the auxiliary channel of the endoscope. Finally, an endoscopic inspection was performed to visually confirm complete closure. The patient did not develop any adverse events and was discharged on day 2 after EMR. An endoscopic control 2.5 months after showed a healed mucosa.

Conclusions The string-hemoclip fusión procedure for closing a large mucosal defect after EMR was feasible, effective, and safe. An advantage of this method could be to get a stronger mucosal closure by a zigzag line fashion.