Clip-fixed endoloop: an efficacious new method for mucosal defect closure
21 February 2018 (online)
Endoloop suturing of a mucosal defect using a two-channel scope has been shown to be efficacious  . Recently, methods of simple, useful endoloop suturing with a single-channel scope have also been reported  . However, fixing the first clip to determine the position of the endoloop is cumbersome. We have developed a new and efficient suturing method, the clip-fixed endoloop, that fixes the endoloop to the clip in advance.
The clip-fixed endoloop consists of the clip (ZEOCLIP ZP-CH; Zeon Medical Inc.), a clip applicator (ZP-S-195S; Zeon Medical Inc.), an endoloop (MAJ254; Olympus), and a surgical thread ([Fig. 1 a]). [Video 1] shows how to perform mucosal closure using the clip-fixed endoloop. First, the tip of endoloop is fixed to the clip’s teeth with surgical thread ([Fig. 1 b]). The clip-fixed endoloop is housed in the outer sheath of the clip by moving the outer slider distally until the clip-fixed endoloop is completely hidden in the outer sheath ([Fig. 1 c]). It is opened by slowly moving the outer sheath until it is endoscopically confirmed that the endoloop is properly open.
Video 1 The clip-fixed endoloop is prepared and then used to suture a mucosal defect after colorectal endoscopic submucosal dissection.
[Video 1] shows how the mucosal defect is sutured after colorectal endoscopic submucosal dissection (ESD) using the clip-fixed endoloop. The patient had a 40-mm sessile serrated adenoma in the descending colon. ESD was performed; the area of the mucosal defect after ESD was slightly larger than 40 mm ([Fig. 2 a]). The clip-fixed endoloop was inserted through the working channel of the endoscope and was confirmed to be opening properly ([Fig. 2 b]). It was then fixed onto the normal mucosa near the mucosal defect ([Fig. 2 c]). Four metal clips were used to anchor the endoloop around the edge of the mucosal defect. The endoloop tail was then grasped by a hook device (HX-20Q-1; Olympus) and the endoloop was tightened to close the defect. Additional clips were added to the remaining mucosal defect to ensure it was completely sutured ([Fig. 2 d]).
By fixing the endoloop to the clip in advance and housing it in the outer sheath, we have made simple and efficient suturing of a mucosal defect possible.
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