Feasibility of 'Clip with Line Pulley Securing (CLiPS)' Technique for closure after colorectal ESD

Aims Closure for post colorectal endoscopic submucosal dissection (ESD) defect is expected to reduce delayed adverse events, such as delayed bleeding (DB) and delayed perforation (DP). While there are several reports supporting the efficacy of closure, a standard method has not been established due to factors including the complexity of the procedure and the high cost of the required devices. We recently developed an easily applicable and economical “Clip with Line Pulley Securing (CLiPS)” technique for approximating large defects using a single channel endoscope. This study aims to report on the feasibility of this technique for closure of colorectal defects post ESD [1].

Methods We retrospectively analyzed 70 colorectal ESD cases that underwent closure using CLiPS technique between February 2023 and November 2024. CLiPS technique involves deployment of a “clip with nylon line” on the distal edge of the post ESD defect, followed by another clip securing the line onto the proximal edge. The edges are approximated by passing the line through an endoloop, which is then pushed in through the accessory channel to pull the edges together. After the endoloop is deployed to secure the line, the line is cut, and final closure is completed with conventional clips. In large defects, ｍultiple CLiPS techniques can be used when necessary. The primary outcomes were complete closure rate and adverse events (AEs). The secondary outcomes were closure time and defect size.

Results Complete closure of the post ESD defect was achieved in 67 cases (95.7%). Mean size of the defect was 46.3 mm (range: 20-100 mm), and the mean closure time was 20.1 minutes (range: 5-58 minutes), with no intraprocedural adverse events. On average, 1.35 (range: 1-4) CLiPS techniques were used, requiring a mean of 8.9 hemoclips (range: 3-15 clips) for closure. There was one case (1.4%) of delayed bleeding (DB), and one case (1.4%) of delayed perforation (DP). DB occurred in a case with incomplete closure in the sigmoid colon, where maneuverability was limited. DP was observed in a case with a 60 mm defect. Upon emergency endoscopy, both DB and DP cases revealed dehisced mucosa, both of which were managed with endoscopic clipping. The mean duration of hospital stay was 4 days (range: 2-10 days).

Conclusions Complete closure of the post ESD colorectal defect using CLiPS is a feasible and safe method. Prospective validation of its usefulness is planned in the future.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Kobara H, Tada N, Fujihara S, Nishiyama N, Masaki T.. Clinical and technical outcomes of endoscopic closure of postendoscopic submucosal dissection defects: Literature review over one decade. Dig Endosc 2023; 35 (2): 216-31

Publication History

Article published online:
27 March 2025