Endoscopic closure of a colonic defect using a novel endoloop system via a single-channel endoscope
14 April 2016 (online)
Successful closure of postoperative defects is essential for endoscopic resection of early neoplasms. The endoscopic purse-string suture (EPSS) using a double-channel colonoscope has been shown to be safe and effective. This method involves the interaction of the endoloop and the metal clips through two separate endoscope channels . However, single-channel colonoscopes are more popular in clinical practice because of their longer length, more flexible operation, and cheaper price, especially when used in the right colon. We report on a novel endoloop system that was innovatively applied via a single-channel endoscope.
A 70-year-old man was referred to our center with a 9-month history of increasing defecation. Endoscopic examination with biopsy and histopathology revealed a nongranular type of laterally spreading tumor with moderate atypical hyperplasia in the ileocecal junction. Endoscopic submucosal dissection was performed for en bloc resection. The large defect (2.5 × 2.0 cm) was completely closed by EPSS via a single-channel colonoscope (CF Q260; Olympus, Tokyo, Japan), as follows. As an independent device, the nylon loop (Loop-30; LeCamp, Changzhou, China) was first delivered and positioned around the defect. Multiple clips were then applied to fix the endoloop in place. The loop was tightened by grasping the tail with a hook and pulling backward to close the defect ([Fig. 1], [Video 1]). The entire procedure was completed via the single channel. The closing process took 8 minutes. The patient was discharged 2 days after the operation without any adverse events.
Lua et al.  described their experience of closing a mucosal defect in the stomach using a single-channel gastroscope. To our knowledge, the current case is the first report on closure of a colonic defect via a single-channel colonoscope. With the assistance of an independent endoloop system, EPSS via a single-channel colonoscope should be feasible, efficient, and safe for endoscopic defect closure.
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- 2 Lua GW, Liu F. Closure of large mucosal defect after endoscopic submucosal dissection using “pre-detached loop and clips” method with a single-channel gastroscope. Endoscopy 2015; 47: E464-E465