CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(01): E11-E16
DOI: 10.1055/s-0042-121002
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Technical feasibility of line-assisted complete closure technique for large mucosal defects after colorectal endoscopic submucosal dissection

Minoru Kato
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Yoji Takeuchi
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Yasushi Yamasaki
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Masamichi Arao
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Sho Suzuki
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Taro Iwatsubo
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Kenta Hamada
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Yusuke Tonai
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Satoki Shichijo
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Noriko Matsuura
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Hiroko Nakahira
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Takashi Kanesaka
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Tomofumi Akasaka
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Noboru Hanaoka
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Koji Higashino
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Noriya Uedo
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Ryu Ishihara
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Hiroyasu Iishi
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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Weitere Informationen

Publikationsverlauf

submitted 27. Juli 2016

accepted after revision 24. Oktober 2016

Publikationsdatum:
20. Januar 2017 (online)

Abstract

Background and study aims Complete closure of large mucosal defects after colorectal endoscopic submucosal dissection (C-ESD) is considered impossible in most cases because of the limited width of the open clip. We therefore invented a simple closure technique using clip-and-line, named “line-assisted complete closure (LACC)”, and assessed its technical feasibility.

Patients and methods Between January and February 2016, we performed LACC in 11 patients after C-ESD and included them in this retrospective feasibility study. Outcome measures were procedural success rate, procedure time, and post-procedural complications.

Results The median size of the resected specimen was 36 mm (range 30 – 72 mm). Procedural success was achieved in 10 of 11 cases (91 %). Those 10 cases required a median of 9 endoclips (range 6 – 12) for complete closure. Median procedure time for LACC was 14 minutes (range 6 – 22). No complications were observed in any of the cases after the procedure.

Conclusion LACC is a simple and feasible technique for complete closure of large mucosal defects after C-ESD.

 
  • References

  • 1 Takeuchi Y, Iishi H, Tanaka S. et al. Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort. Int J Colorectal Dis 2014; 29: 1275-1284
  • 2 Yamashina T, Takeuchi Y, Uedo N. et al. Features of electrocoagulation syndrome after endoscopic submucosal dissection for colorectal neoplasm. J Gastroenterol Hepatol 2016; 31: 615-620
  • 3 Zhang QS, Han B, Xu JH. et al. Clip closure of defect after endoscopic resection in patients with larger colorectal tumors decreased the adverse events. Gastrointest. Endosc 2015; 82: 904-909
  • 4 Fujihara S, Mori H, Kobara H. et al. The efficacy and safety of prophylactic closure for a large mucosal defect after colorectal endoscopic submucosal dissection. Oncol Rep 2013; 30: 85-90
  • 5 Kato M, Takeuchi Y, Yamasaki Y. Line-assisted complete closure of a large colorectal mucosal defect after endoscopic submucosal dissection. Dig Endosc 2016; 28: 686
  • 6 Yamasaki Y, Takeuchi Y, Hanaoka N. et al. A novel traction method using an endoclip attached to a nylon string during colonic endoscopic submucosal dissection. Endoscopy 2015; 47: E238-E239
  • 7 Suzuki S, Gotoda T, Kobayashi Y. et al. Usefulness of a traction method using dental floss and a hemoclip for gastric endoscopic submucosal dissection: a propensity score matching analysis (with videos). Gastorointest Endosc 2015; 83: 337-346
  • 8 Fujii T, Ono A, Fu K. A novel endoscopic suturing technique using a specially designed so-called “8-ring” in combination with resolution clips (with videos). Gastrointes Endosc 2007; 66: 1215-1220
  • 9 Sakamoto N, Beppu K, Matsumoto K. et al. “Loop Clip”, a new closure device for large mucosal defects after EMR and ESD. Endoscopy 2008; 40: E97-E98
  • 10 Mori H, Sakamoto N, Osada T. et al. The “Loop clip” is useful for closing large mucosal defects after colorectal endoscopic submucosal dissection: a preliminary clinical study. Dig Endosc 2011; 23: 330-331
  • 11 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
  • 12 Yahagi N, Nishizawa T, Akimoto T. et al. New endoscopic suturing method: “String clip suturing method”. Gastrointest Endosc 2016; 84: 1064-1065
  • 13 Schurr MO, Hartmann C, Ho CN. et al. An over-the-scope clip (OTSC) system for closure of iatrogenic colon perforations: results of an experimental survival study in pigs. Endoscopy 2008; 40: 584-588
  • 14 Maekawa S, Nomura R, Murase T. et al. Complete closure of artificial gastric ulcer after endoscopic submucosal dissection by combined use of single over-the-scope clip and through-the-scope clips (with videos). Surg Endosc 2015; 29: 500-504
  • 15 Takimoto K, Toyonaga T, Matsuyama K. Endoscopic tissue shielding to prevent delayed perforation associated with endoscopic submucosal dissection for duodenal neoplasms. Endoscopy 2012; 44: E414-415
  • 16 Tsuji Y, Ohata K, Gunji T. et al. Endoscopic tissue shielding method with polyglycolic acid sheets and fibrin glue to cover wounds after colorectal endoscopic submucosal dissection (with video). Gastrointest Endosc 2014; 79: 151-155
  • 17 Yamasaki Y, Takeuchi Y, Kato M. et al. Line-assisted complete closure of large gastric mucosal defect using multiple clip-and-line technique. VideoGIE 2016; 1: 49-50