Endoscopy 2022; 54(10): E600-E601
DOI: 10.1055/a-1711-4091
E-Videos

Successful mucosal closure of artificial gastric ulcer with twin grasping forceps and endoclips after endoscopic submucosal dissection

Department of Gastroenterology, Omori Red Cross Hospital, Chuo, Ota-Ku, Tokyo, Japan
,
Department of Gastroenterology, Omori Red Cross Hospital, Chuo, Ota-Ku, Tokyo, Japan
,
Keiji Yamada
Department of Gastroenterology, Omori Red Cross Hospital, Chuo, Ota-Ku, Tokyo, Japan
,
Naoya Okada
Department of Gastroenterology, Omori Red Cross Hospital, Chuo, Ota-Ku, Tokyo, Japan
,
Jun Arimoto
Department of Gastroenterology, Omori Red Cross Hospital, Chuo, Ota-Ku, Tokyo, Japan
,
Department of Gastroenterology, Omori Red Cross Hospital, Chuo, Ota-Ku, Tokyo, Japan
,
Toru Goto
Department of Gastroenterology, Omori Red Cross Hospital, Chuo, Ota-Ku, Tokyo, Japan
› Author Affiliations
 

The risk of postoperative adverse events following endoscopic resection can be reduced through endoscopic closure of the artificial gastric ulcer [1], but it is not easy owing to the gastric wall thickness and hardness. There are several methods for closing ulcers induced by gastric endoscopic submucosal dissection (ESD) [2] [3] [4] [5]. Here, we describe the successful simple closure of a post-gastric ESD artificial ulcer using twin grasping forceps (Twin Grasper; Ovesco Endoscopy AG, Tubingen, Germany) and endoclips (EZ clip; Olympus, Tokyo, Japan).

An 89-year-old man with early gastric cancer (upper part of the gastric greater curvature) underwent ESD that resulted in a mucosal defect (artificial gastric ulcer, diameter 20 mm) ([Fig. 1], [Fig. 2]) that was subsequently closed as follows ([Video 1]).

Zoom Image
Fig. 1 Early gastric cancer (tumor diameter 3 mm) located in the greater curvature of the upper body of the stomach.
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Fig. 2 Endoscopic submucosal dissection was performed and resulted in a mucosal defect (diameter 20 mm).

Video 1 Twin grasping forceps and endoclips used for successful mucosal closure of artificial gastric ulcer after endoscopic submucosal dissection.


Quality:

(1) A double-channel endoscope (GIF-2TQ260M; Olympus) was inserted to visualize the mucosal defect in a straight view. (2) A Twin Grasper was inserted through the first channel and rotated. One arm grasped the edge of the ulcer, then the other arm grasped opposite edge, and the two sides of the ulcer contacted completely ([Fig. 3]). (3) An EZ clip inserted through the second channel was rotated into an appropriate position and the sheath of the Twin Grasper was drawn to pull both of the grasped edges of the ulcer into the crotch of the clip, where they were closed ([Fig. 4]). (4) These steps were repeated until the defect was completely closed (procedure duration 11.7 min) ([Fig. 5]). The patient was discharged 5 days after ESD without adverse events.

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Fig. 3 The two arms of the Twin Grasper were used to grasp and appose both edges of the artificial ulcer.
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Fig. 4 The sheath of the Twin Grasper was drawn to pull both the grasped edges of the ulcer into the crotch of the EZ clip, and clip closure was performed.
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Fig. 5 Complete closure was performed in 11.7 min.

The advantage of the abovementioned Twin Grasper and EZ clip-based mucosal defect closure method is that the Twin Grasper enables the apposition of ulcer edges as though undertaken manually and facilitates defect closure under direct visualization. Therefore, this easy closure method will be one of the effective and safe options for closing a post-ESD artificial gastric ulcer.

Endoscopy_UCTN_Code_CPL_1AJ_2AD

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Competing interests

The authors declare that they have no conflict of interest.

  • References

  • 1 Choi KD, Jung HY, Lee GH. et al. Application of metal hemoclips for closure of endoscopic mucosal resection-induced ulcers of the stomach to prevent delayed bleeding. Surg Endosc 2008; 22: 1882-1886
  • 2 Shiotsuki K, Takizawa K, Notsu A. et al. Endoloop closure following gastric endoscopic submucosal dissection to prevent delayed bleeding in patients receiving antithrombotic therapy. Scand J Gastroenterol 2021; 56: 1117-1125
  • 3 Kobara H, Mori H, Fujihara S. et al. Outcomes of gastrointestinal defect closure with an over-the-scope clip system in a multicenter experience: An analysis of a successful suction method. World J Gastroenterol 2017; 23: 1645-1656
  • 4 Han S, Wani S, Edmundowicz SA. Feasibility of endoscopic suturing to prevent adverse events and hospitalization after endoscopic submucosal dissection. Endosc Int Open 2020; 8: 1212-1217
  • 5 Akimoto T, Goto O, Sasaki M. et al. Endoscopic hand suturing for mucosal defect closure after gastric endoscopic submucosal dissection may reduce the risk of postoperative bleeding in patients receiving antithrombotic therapy. Dig Endosc 2021; DOI: 10.1111/den.14045.

Corresponding author

Hideyuki Chiba, MD, PhD
Department of Gastroenterology
Omori Red Cross Hospital
4-30-1, Chuo, Ota-Ku
Tokyo, 143-0024
Japan   
Fax: +81-3-3776-0004   

Publication History

Article published online:
21 December 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Choi KD, Jung HY, Lee GH. et al. Application of metal hemoclips for closure of endoscopic mucosal resection-induced ulcers of the stomach to prevent delayed bleeding. Surg Endosc 2008; 22: 1882-1886
  • 2 Shiotsuki K, Takizawa K, Notsu A. et al. Endoloop closure following gastric endoscopic submucosal dissection to prevent delayed bleeding in patients receiving antithrombotic therapy. Scand J Gastroenterol 2021; 56: 1117-1125
  • 3 Kobara H, Mori H, Fujihara S. et al. Outcomes of gastrointestinal defect closure with an over-the-scope clip system in a multicenter experience: An analysis of a successful suction method. World J Gastroenterol 2017; 23: 1645-1656
  • 4 Han S, Wani S, Edmundowicz SA. Feasibility of endoscopic suturing to prevent adverse events and hospitalization after endoscopic submucosal dissection. Endosc Int Open 2020; 8: 1212-1217
  • 5 Akimoto T, Goto O, Sasaki M. et al. Endoscopic hand suturing for mucosal defect closure after gastric endoscopic submucosal dissection may reduce the risk of postoperative bleeding in patients receiving antithrombotic therapy. Dig Endosc 2021; DOI: 10.1111/den.14045.

Zoom Image
Fig. 1 Early gastric cancer (tumor diameter 3 mm) located in the greater curvature of the upper body of the stomach.
Zoom Image
Fig. 2 Endoscopic submucosal dissection was performed and resulted in a mucosal defect (diameter 20 mm).
Zoom Image
Fig. 3 The two arms of the Twin Grasper were used to grasp and appose both edges of the artificial ulcer.
Zoom Image
Fig. 4 The sheath of the Twin Grasper was drawn to pull both the grasped edges of the ulcer into the crotch of the EZ clip, and clip closure was performed.
Zoom Image
Fig. 5 Complete closure was performed in 11.7 min.