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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(08): E697-E702
DOI: 10.1055/a-2095-0033
Original article

Reopenable clip-over-the-line method for closing large mucosal defects following colorectal endoscopic submucosal dissection: A feasibility study

Tatsuma Nomura 
1   Gastroenterology, Ise Red Cross Hospital, Ise-shi, Japan
2   Gastroenterology, Mie Prefectural Shima Hospital, Shima-shi, Japan
,
Shinya Sugimoto
1   Gastroenterology, Ise Red Cross Hospital, Ise-shi, Japan
,
Taishi Temma
1   Gastroenterology, Ise Red Cross Hospital, Ise-shi, Japan
,
Jun Oyamada
1   Gastroenterology, Ise Red Cross Hospital, Ise-shi, Japan
,
Keiichi Ito
2   Gastroenterology, Mie Prefectural Shima Hospital, Shima-shi, Japan
,
Akira Kamei
1   Gastroenterology, Ise Red Cross Hospital, Ise-shi, Japan
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Correction: Reopenable clip-over-the-line method for closing large mucosal defects following colorectal endoscopic submucosal dissection: A feasibility studyEndosc Int Open 2023; 11(08): C4-C4
DOI: 10.1055/a-2150-5840

Abstract

Background and study aims Complete closure of large defects after colorectal endoscopic submucosal dissection (ESD) can be problematic, especially in challenging areas or lesions larger than half the lumen circumference. We report a reopenable clip-over-the-line method for such defects and aim to investigate its feasibility through a case series.

Patients and methods We retrospectively evaluated data from 30 consecutive patients who underwent ESD with defect closure using the reopenable clip-over-the-line method between October 2020 and September 2022. This method requires the first clip-with-line grasp of the oral side's defect edge and muscle layer. The next reopenable clip (with a line fed through a hole in the reopenable clip tooth) is placed on the opposing mucosal defect edge and muscle layer. This process is repeated until complete closure. The primary study outcome was the rate of complete mucosal defect closure. We also reported post-procedure bleeding or perforation.

Results The median dimensions of the resected specimens were 45 mm (range, 35–70) by 39 mm (range, 29–60). Complete closure was achieved for all defects, including nine rectal defects, of which three bordered the anal verge. Of the 30 defects included in this study, nine were larger than half the lumen circumference. The median closure time was 25 minutes (range, 14–52), and the median clip number was 17 (range, 9–42). No post-procedure bleeding or perforation occurred.

Conclusions The reopenable clip-over-the-line method is a feasible technique for the complete closure of large colorectal defects after endoscopic submucosal dissection, regardless of location.



Publication History

Received: 11 November 2022

Accepted after revision: 09 May 2023

Accepted Manuscript online:
16 May 2023

Article published online:
01 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Ohata K, Kobayashi N, Sakai E. et al. Long-term outcomes after endoscopic submucosal dissection for large colorectal epithelial neoplasms: a prospective, multicenter, cohort trial from Japan. Gastroenterology 2022; 163: 1423-1434.e2
    CrossrefPubMedSearch in Google Scholar
  • 2 Liu M, Zhang Y, Wang Y. et al. Effect of prophylactic closure on adverse events after colorectal endoscopic submucosal dissection: A meta-analysis. J Gastroenterol Hepatol 2020; 35: 1869-1877
    CrossrefPubMedSearch in Google Scholar
  • 3 Nomura T, Sugimoto S, Temma T. et al. Reopenable clip over-the-line method with muscle layer grasping clips for large duodenal post-endoscopic submucosal dissection defects. Endoscopy 2022; 54: E782-E783
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Nomura T, Matsuzaki I, Sugimoto S. et al. Clip-on-clip closure method for a mucosal defect after colorectal endoscopic submucosal dissection: a prospective feasibility study. Surg Endosc 2020; 34: 1412-1416
    CrossrefPubMedSearch in Google Scholar
  • 5 Kato M, Takeuchi Y, Yamasaki Y. et al. Technical feasibility of line-assisted complete closure technique for large mucosal defects after colorectal endoscopic submucosal dissection. Endosc Int Open 2017; 5: E11-E16
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Nomura T, Sugimoto S, Temma T. et al. Suturing techniques with endoscopic clips and special devices after endoscopic resection. Dig Endosc 2022; 35: 287-301
    CrossrefPubMedSearch in Google Scholar
  • 7 Otake Y, Saito Y, Sakamoto T. et al. New closure technique for large mucosal defects after endoscopic submucosal dissection of colorectal tumors (with video). Gastrointest Endosc 2012; 75: 663-667
    Search in Google Scholar
  • 8 Fujihara S, Mori H, Kobara H. et al. The efficacy and safety of prophylactic closure for a large mucosal defect after colorectal endoscopic dissection. Oncol Rep 2013; 30: 85-90
    CrossrefPubMedSearch in Google Scholar
  • 9 Tada N, Kobara H, Nishiyama N. et al. Endoscopic ligation with O-ring closure for a large artificial defect after rectal endoscopic submucosal dissection. Dig Liver Dis 2022; 54: 142-143
    CrossrefPubMedSearch in Google Scholar
  • 10 Nomura T, Sugimoto S, Kawabata M. et al. Large colorectal mucosal defect closure post-endoscopic submucosal dissection using the reopenable clip over line method and modified locking-clip technique. Endoscopy 2022; 54: E63-E64
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Nomura T, Sugimoto S, Temma T. et al. Mucosal defect closure using a calibrated, small-caliber-tip, transparent hood after colorectal endoscopic submucosal dissection. Endoscopy 2022; 54: E691-E692
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Nomura T, Sugimoto S, Nakamura H. et al. Reopenable clip over line method for the closure of full-thickness defect after gastric endoscopic full-thickness resection. Endoscopy 2022; 54: E808-E809
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Abe S, Saito Y, Tanaka Y. et al. A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study. Endoscopy 2020; 52: 780-785
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Kantsevoy SV, Bitner M, Mitrakov AA. et al. Endoscopic suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible, fast, and eliminates the need for hospitalization (with videos). Gastrointest Endosc 2014; 79: 503-507
    Search in Google Scholar
  • 15 Albéniz E, Álvarez MA, Espinós JC. et al. Clip closure after resection of large colorectal lesions with substantial risk of bleeding. Gastroenterology 2019; 157: 1213-1221.e4
    CrossrefPubMedSearch in Google Scholar
  • 16 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
    CrossrefPubMedSearch in Google Scholar
  • 17 Yamasaki Y, Takeuchi Y, Iwatsubo T. et al. Line-assisted complete closure for a large mucosal defect after colorectal endoscopic submucosal dissection decreased post-electrocoagulation syndrome. Dig Endosc 2018; 30: 633-641
    Search in Google Scholar
  • 18 Yoshida A, Kurumi H, Ikebuchi Y. et al. New closure method using loop and open-close clips after endoscopic submucosal dissection of stomach and colon lesions. J Clin Med 2021; 10: 3260
    CrossrefPubMedSearch in Google Scholar
  • 19 Tada N, Kobara H, Nishiyama N. et al. Endoscopic ligation with O-ring closure for mucosal defects after rectal endoscopic submucosal dissection: a feasibility study (with video). Digestion 2023; 11: 1-10
    PubMedSearch in Google Scholar
  • 20 Akimoto T, Goto O, Sasaki M. et al. Endoscopic suturing promotes healing of mucosal defects after gastric endoscopic submucosal dissection: endoscopic and histologic analyses in in vivo porcine models (with video). Gastrointest Endosc 2020; 91: 1172-1182
    CrossrefPubMedSearch in Google Scholar
  • 21 Nomura T, Sugimoto S, Temma T. et al. Reopenable clip-over-the-line method for closing large mucosal defects following gastric endoscopic submucosal dissection: Prospective feasibility study. Dig Endosc 2022; 35: 505-511
    CrossrefPubMedSearch in Google Scholar