Endoscopy 2022; 54(11): 1125
DOI: 10.1055/a-1901-8594
Letter to the editor

Endoscopic ligation technique with O-ring closure: improved or complicated?

Zhi-Han Wu*
1   Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
2   Sichuan University–Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
,
Mo Chen*
3   Department of Gerontology, Tibetan Chengdu Branch Hospital of West China Hospital, Sichuan University, Chengdu, China
4   Department of Gerontology, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, China
,
Kai Deng
1   Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
2   Sichuan University–Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
› Author Affiliations

Nishiyama et al. [1] recently published the results of a prospective observational study that examined the efficacy of a novel endoscopic ligation technique with O-ring closure (E-LOC) to prevent bleeding after gastric endoscopic submucosal dissection (ESD) in patients on antithrombotic therapy. The authors concluded that E-LOC may be an effective method of closing mucosal defects after gastric ESD. The procedure of E-LOC was illustrated clearly, and we would like to know more.

Compared with other methods for mucosal defect closure, E-LOC shows acceptable maneuverability and convenient availability. However, it seems that applying an O-ring might complicate the operation and prolong the procedure time, as the other elements of the procedure, which are quite similar to the routine loop-and-clips technique, could prevent post-procedure bleeding in most cases [2] [3]. It is essential to share the E-LOC technique and highlight its novelty and improvement in the discussion, which contributes to deep understanding, wide acceptance, and clinical potential. Moreover, bleeding after gastric ESD is not common where closure is not routinely recommended [4]. Doubts remain as to whether endoscopic closure of the mucosal defect could prevent post-ESD bleeding, not to mention whether a new closure method, E-LOC, could minimize the risk of bleeding. While the findings are likely to be highly impactful, further prospective studies are needed for validation of the novel technique.

We appreciate the work by Nishiyama et al. Despite the promising data, we eagerly await more statements about the advantages and disadvantages before applying E-LOC in the clinical setting.

* Co-first authors.




Publication History

Article published online:
27 October 2022

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