Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are
indicated for the treatment of large early-stage superficial colorectal cancers. Bleeding
and perforation are common complications of EMR and ESD, but closure of the mucosal
defect reduces the risk of complications. Hemoclips have been used for endoscopic
closure of EMR defects, but they can only be used when the diameter of the defect
is less than the width of the open clip. Because it is quite difficult to do, it is
not common to close large mucosal defects despite the increased risk of bleeding and
perforation. A few techniques involving closure devices have been reported [1 ]
[2 ], but these complicated methods have not been widely employed because of the need
for a 2-channel colonoscope. Therefore, we designed a new closure device for large
mucosal defects, named a “loop clip”.
The loop clip consists of a metal clip attached to a loop of nylon string ([Fig. 1 ]). The loop clip can be passed through the instrument channel of the endoscope ([Fig. 2 ]). After EMR and ESD, a loop clip is connected to the edge of the mucosal defect
at the mid of distal side and the mid of proximal side ([Fig. 3 ] and [4 ]). Afterwards, regular clips are placed individually to achieve complete closure.
Complete closure of mucosal defects using the loop clip has been performed on three
large mucosal defects after ESD (mean size, 39 mm). We confirm that it was easy to
close any mucosal defect completely and immediately using the loop clip. These preliminary
results suggest that loop clip-assisted complete closure of mucosal defects is effective
and easy to do and can be done immediately. None of the patients developed fecal peritonitis
or delayed bleeding. In the future, this method of suturing is expected to become
successful for immediate closure of gaping perforations.
Fig. 1 The loop clip consists of a metallic clip attached to a loop of nylon string.
Fig. 2 The loop clip can be passed through the instrument channel of the endoscope.
Fig. 3 a After endoscopic mucosal resection and endoscopic submucosal dissection, the clip
is connected to the edge of the mucosal defect at the distal side. b, c Then a regular clip is inserted and attached to the colonic wall near the edge of
the mucosal defect at the proximal side, after having first grasped the nylon loop
attached to the loop clip.
Fig. 4 Loop clip for large mucosal defects after endoscopic submucosal dissection in the
ascending colon.
Video
1 Loop clip for large mucosal defects after endoscopic submucosal dissection in the
cecum.
Competing interests: None
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