Approximation of Large Mucosal Defects after Endoscopic Mucosal Resection: A New Technique Using a Detachable Snare and Clips

Abstract

Background/Aim: With the advance of endoscopic mucosal resection (EMR) technique, en-bloc resection of larger mucosal lesion is feasible nowadays. But prolonged hospital stay due to large mucosal defect and complications including bleeding and perforations after EMR are other problems. Routine mucosal closure after EMR may decrease hospital stay and complications. However, conventional clipping is impossible for large mucosal defects. So, we developed a new approximation technique using a detachable snare and clips for large mucosal defects after EMR. Methods: After the EMR with an insulation-tipped electrosurgical knife, a detachable snare was spread on the mucosal defect via a double-channel endoscopy. Then a rotating clip-fixing device with a clip was inserted through the other channel of the endoscopy. After placing the wire of the detachable snare between both legs of the clip, this was applied to the mucosal edge of the iatrogenic ulcer. Three to five more clips were placed symmetrically at the mucosal edge in this way, and then the snare was squeezed gently. After approximation of the mucosal defect, additional long clips were applied to dehiscence area for complete closure (Fig. 1). Results: Near complete closures for iatrogenic mucosal defects could be accomplished with this technique. Approximations were maintained at day 5 endoscopy. Conclusions: Approximation technique using a detachable snare and clips is very useful for large mucosal defects after endoscopic mucosal resection. Studies for impacts on hospital stay and complications are needed.