Feasibility of endoscopic mucosa-submucosa clip closure method (with video)

Toshihiro Nishizawa; Shigeo Banno; Satoshi Kinoshita; Hideki Mori; Yoshihiro Nakazato; Yuichiro Hirai; Yoko Kubosawa; Yukie Sunata; Misako Matsushita; Toshio Uraoka

doi:10.1055/a-0630-0566

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(08): E1070-E1074
DOI: 10.1055/a-0630-0566

Original article

Feasibility of endoscopic mucosa-submucosa clip closure method (with video)

Authors

Toshihiro Nishizawa

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
Shigeo Banno

²Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
Satoshi Kinoshita

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
Hideki Mori

²Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
Yoshihiro Nakazato

³Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
Yuichiro Hirai

²Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
Yoko Kubosawa

²Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
Yukie Sunata

²Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
Misako Matsushita

²Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
Toshio Uraoka

²Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

Abstract

Background and study aims We developed a new endoscopic closure technique using just conventional endoclips. The feasibility of endoscopic mucosa-submucosa clip closure method was evaluated in this clinical pilot study.

Patients and methods This study involved consecutive 25 patients who underwent colorectal endoscopic submucosal dissection. Endoclips were placed at the edge of the mucosal defect. Each arm of the endoclip gripped the mucosa and submucosa, respectively. The direction in which the endoclip grips were placed was parallel to the short axis of the defect. Several endoclips were applied in this way. As a result, the mucosal defect was significantly reduced in size. Additional clips were placed to achieve complete closure.

Results Mean size of resected specimen was 31.2 ± 11 mm. The success rate was 96 % (24/25). Mean procedure time was 9.6 ± 4.4 minutes. Mean number of endoclips was 9.3 ± 3.7. No complications were observed in any of the patients after the procedure.

Conclusion Endoscopic mucosa-submucosa clip closure method could close mucosal defect of size around 2 – 4 cm completely using just conventional endoclips, and it seems easy, simple and low cost.

Full Text

References

References
1 Kinoshita S, Uraoka T, Nishizawa T. et al. The role of colorectal endoscopic submucosal dissection in patients with ulcerative colitis. Gastrointest Endosc 2018; 87: 1079-1084
2 Uraoka T, Parra-Blanco A, Yahagi N. Colorectal endoscopic submucosal dissection in Japan and Western countries. Dig Endosc 2012; 24 (Suppl. 01) 80-83
3 Nishizawa T, Uraoka T, Suzuki H. et al. Control of the treatment device for endoscopy by the left hand: two-fingers method. Gastrointest Endosc 2014; 80: 1206-1207
4 Nishizawa T, Uraoka T, Suzuki H. et al. Control of tip deflection by right pinkie shaft grip: right pinkie maneuver. Gastrointest Endosc 2014; 80: 1208
5 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
6 Arezzo A, Passera R, Marchese N. et al. Systematic review and meta-analysis of endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal lesions. United European Gastroenterol J 2016; 4: 18-29
7 Kobayashi N, Yoshitake N, Hirahara Y. et al. Matched case-control study comparing endoscopic submucosal dissection and endoscopic mucosal resection for colorectal tumors. J Gastroenterol Hepatol 2012; 27: 728-733
8 Fujishiro M, Yahagi N, Kakushima N. et al. Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 2007; 5: 678-683 ; quiz 45
9 Isomoto H, Nishiyama H, Yamaguchi N. et al. Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 2009; 41: 679-683
10 Ono S, Fujishiro M, Yoshida N. et al. Thienopyridine derivatives as risk factors for bleeding following high risk endoscopic treatments: Safe Treatment on Antiplatelets (STRAP) study. Endoscopy 2015; 47: 632-637
11 Akimoto T, Goto O, Nishizawa T. et al. Endoscopic closure after intraluminal surgery. Dig Endosc 2017; 29: 547-558
12 Liaquat H, Rohn E, Rex DK. Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions. Gastrointest Endosc 2013; 77: 401-407
13 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
14 Matsuda T, Fujii T, Emura F. et al. Complete closure of a large defect after EMR of a lateral spreading colorectal tumor when using a two-channel colonoscope. Gastrointest Endosc 2004; 60: 836-838
15 Nishizawa T, Uraoka T, Suzuki H. et al. New endoscopic suturing method: slip knot clip suturing. Gastrointest Endosc 2015; 82: 570-571
16 Nishizawa T, Uraoka T, Sagara S. et al. Endoscopic slipknot clip suturing method: an ex vivo feasibility study (with video). Gastrointest Endosc 2016; 83: 447-450
17 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
18 Yahagi N, Nishizawa T, Akimoto T. et al. New endoscopic suturing method: string clip suturing method. Gastrointest Endosc 2016; 84: 1064-1065
19 Nishizawa T, Akimoto T, Uraoka T. et al. Endoscopic string clip suturing method: a prospective pilot study (with video). Gastrointest Endosc 2018; 87: 1074-1078
20 Osada T, Sakamoto N, Ritsuno H. et al. Process of wound healing of large mucosal defect areas that were sutured by using a loop clip-assisted closure technique after endoscopic submucosal dissection of a colorectal tumor. Gastrointest Endosc 2013; 78: 793-798
21 Banno S, Nishizawa T, Kinoshita S. et al. Endoscopic mucosa-submucosal clip closure method. Endoscopy 2017; 49: E307-E308
22 Nishizawa T, Suzuki H, Goto O. et al. Effect of prophylactic clipping in colorectal endoscopic resection: A meta-analysis of randomized controlled studies. United European Gastroenterol J 2017; 5: 859-867
23 Wang J, Zhao L, Wang X. et al. A novel endoloop system for closure of colonic mucosal defects through a single-channel colonoscope. Endoscopy 2017; 49: 803-807
24 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
25 Hochberger J, Wedi E, Tchoumak I. et al. Over-the-scope clip placement and endosponge insertion for prevention of pancreatic enzyme-induced duodenal damage after large duodenal endoscopic resection. Endoscopy 2016; 48: E401-E402
26 von Renteln D, Schmidt A, Vassiliou MC. et al. Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study. Endoscopy 2009; 41: 481-486