Single-channel endoscopic closure of a mucosal defect after endoscopic submucosal dissection using a disposable endoloop and a retrievable clip.

Abstract

Endoscopic submucosal dissection (ESD) is a treatment with high rate of en bloc resection. It has been suggested that mucosal suture of post-ESD ulcers may reduce the incidence of delayed accidents. Suturing method for the ulcers and deep tears that use a single-channel scope and a reusable endoloop (Olympus, Tokyo, Japan) and ones that use a double-channel scope have been reported. Notably, due to difficulties in using a a reusable loop, we devised a suturing method that uses a single-channel scope, a disposable endoloop, and a SureClip (Micro-tech Endoscopy, Nanjing, China). The SureClip was inserted into the forceps hole and withdrawn from the tip. The loop portion of the endoloop was grasped with the SureClip while the disposable endoloop was halfway out and then delivered into the lumen outside the endoscope. After reaching the target site, the SureClip was opened and secured to one of the mucosa ends. The first clip was placed as far away from the sheath as possible. The use of the SureClip was then continued, for fixation at multiple sites, and the endoloop was tightened and sutured. No complications, such as bleeding or perforation, were observed.