Complete Closure Of Defect Research Articles

Correction: A novel reopenable clip with sharp claw for complete closure of mucosal defects after colorectal endoscopic submucosal dissection.

Correction: A novel reopenable clip with sharp claw for complete closure of mucosal defects after colorectal endoscopic submucosal dissection.

A novel reopenable clip with sharp claw for complete closure of mucosal defects after colorectal endoscopic submucosal dissection.

The MANTIS Closure Device (MCD; Boston Scientific, Marlborough, Massachusetts, USA) is a reopenable clip with a sharp claw used for closure after endoscopic submucosal dissection (ESD). We evaluated the effectiveness of the MCD for fast and complete closure after colorectal ESD. Cases involving closure with the MCD after ESD of 20-60-mm colorectal lesions between April 2023 and January 2024 were reviewed. The primary end point was complete closure of the ESD defect with the MCD. Secondary end points included closure time, delayed bleeding, delayed perforation, and post-ESD coagulation syndrome (PECS). MCD application involved: 1) grasping the mucosa on the anal-side of the defect; 2) pushing the clip toward the oral-side mucosa and deploying it; 3) adding other reopenable clips for complete closure. 61 cases involving MCD were analyzed. Mean tumor size was 32.3 (SD 9.2) mm. Complete closure rate was 98.4% and mean closure time was 6.9 (SD 2.6) minutes. The mean number of MCDs and other clips used was 1.0 (SD 0.1) and 4.7 (SD 1.4), respectively. Rates of delayed bleeding, delayed perforation, and PECS were 0%, 0%, and 9.8%, respectively. Fast and complete closure after colorectal ESD was successfully achieved using the MCD.

Closure of small fenestrations without optimal rims with a PDA coil far from primary atrial septal defects: a new approach.

An ostium secundum atrial septal defect (ASD) is a CHD that can be treated percutaneously since 1974, mostly cases with only one main defect. In cases with fenestrations close to the main defect, a single occluder can be used for treatment because the discs extend beyond the waist of the device. In some cases where the defects are far from each other, they may require either more than one device or surgical closure. We present two patients in whom we observed fenestrations far from the primary defect. Initially, the main ASDs were closed with an ASD occluder, and then the fenestrations were closed with a patent ductus arteriosus (PDA) coil, resulting in complete closure of both defects. This shows that closing small fenestrations that are far away from the primary interatrial defect without rims and using other devices instead, such as a PDA coil, is feasible and can avoid the need for an open-heart surgical procedure; moreover, it is important to note that leaving these fenestrations open can have the same physiology as a patent foramen oval.

Mid-term outcomes of minimally invasive surgery for partial atrioventricular septal defect in children

Objective: This study aims to describe the mid-term outcomes of minimally invasive surgery for partial atrioventricular septal defect in children. Summary: Partial atrioventricular septal defect is one of the three types of atrioventricular septal defect, accounting for about 3.5% of congenital heart disease. Traditionally, complete repair has been performed via sternotomy. However, with the advancement of minimally invasive surgical techniques in treating congenital heart conditions, we conducted this study to assess the feasibility and mid-term outcomes of this approach. Subjects and methods: This descriptive study spanned from January 2018 to December 2023, involving 30 patients diagnosed with partial atrioventricular septal defect who underwent minimally invasive complete repair. The cohort comprised 12 males and 18 females, with an average age of 18 months and average weight of 10.3 kg. The mean diameter of the primary atrial septal defect was 15 mm. Eight patients (26.7%) exhibited moderate to severe mitral regurgitation, and the average pulmonary artery pressure was 37 mmHg. Results: The average durations of cardiopulmonary bypass and aortic cross-clamp were 82 minutes and 58 minutes, respectively. None of the patients required sternotomy. The average time of artificial ventilator post-surgery was 6.9 hours, with a mean hospital stay of 7.6 days. Postoperative echocardiography showed promising results: complete closure of atrial septal defect, with 90% of patients having absent or mild mitral valve regurgitation, only 10% experienced moderate mitral valve regurgitation. The average follow-up period was 38 months, during which there were no postoperative fatalities. One patient required reoperation due to severe mitral regurgitation from an anterior cleft. Conclusion: Minimally invasive surgery for partial atrioventricular septal defect in children can be safely performed, yielding favorable mid-term outcomes during follow-up.

A new through-the-scope clip with anchor prongs is safe and successful for a variety of endoscopic uses.

Background and study aims Endoscopic through-the-scope clips (TTSC) are used for hemostasis and closure. We documented the performance of a new TTSC with anchor prongs. Patients and methods We conducted a prospective case series of the new TTSC in 50 patients with an indication for endoscopic clipping at three hospitals in the United States and Canada. Patients were followed for 30 days after the index procedure. Outcomes included defect closure and rate of serious adverse events (SAEs) related to the device or procedure. Results Fifty patients had 56 clipping procedures. Thirty-four procedures were clipping after endoscopic mucosal resection (EMR) in the colon (33) or stomach (1), 16 after polypectomy, two for hemostasis of active bleeding, and one each for fistula closure, per-oral endoscopic myotomy mucosal closure, or anchoring a feeding tube. Complete defect closure was achieved in 32 of 33 colon EMR defects and 21 of 22 other defects. All clips were placed per labeled directions for use. In 41 patients (82.0%), prophylaxis of delayed bleeding was reported as an indication for endoscopic clipping. There were three instances of delayed bleeding. There were no device-related SAEs. The only technical difficulty was one instance of premature clip deployment. Conclusions A novel TTSC with anchor prongs showed success in a range of defect closures, an acceptable safety profile, and low incidence of technical difficulties.

Regenerative capacity of morselized cartilage in vitro and in an osteochondral defect model

IntroductionNumerous treatment modalities for focal articular cartilage defects exist, including the use of chondrons from minced cartilage morsels. However, the use of consistent and reproducible morsel sizes to heal these lesions, especially with a recently characterized alginate-Nanocellulose (NC) hydrogel scaffold, has not been investigated. MethodsCartilage was harvested and morselized into 0.5mm, 1.0mm, and 5.0mm diameters, and cultured. Cell viability and chondrogenic gene expression was analyzed. 0.5mm diameter minced cartilage morsels were harvested and used to produce the implant paste. The NC paste was filled into a rabbit articular cartilage defect, and histology was used to assess cartilage repair. ResultsChondrocyte viability of the morsels was highly maintained. Chondrogenic and proliferative genes like ACAN, COL2, COMP, PCNA, SOX9, and PRG4 all increased expression to a varying degree as morsel size decreased. 0.5mm morsels exhibited the highest chondrogenic potential. Also, NC paste containing 0.5mm morsels resulted in complete defect closure unlike marrow stimulation alone. Safranin-O staining demonstrated superior cartilage formation in the defect area. DiscussionSmaller consistent morsel size was found to be linked to increased chondrogenic potential, as hypothesized. However, since PRG4 expression was highest in 1mm morsels and MMP-13 gene expression was significantly decreased in only 0.5mm morsels, this demonstrates the need to adjust morsel size to optimize gene expression of interest. NC paste mixed with 0.5mm morsels produced the greatest regenerative capacity. Exploring the regenerative potential of unique hydrogels and chondron morsel sizes is warranted to provide insight on optimizing clinical implants to improve patient recovery.

Endoscopic outcomes using a novel through-the-scope tack and suture system for gastrointestinal defect closure: a systematic review and meta-analysis.

Closure of gastrointestinal defects can reduce postprocedural adverse events. Over-the-scope clips and an over-the-scope suturing system are widely available, yet their use may be limited by defect size, location, operator skill level, and need to reinsert the endoscope with the device attached. The introduction of a through-the-scope helix tack suture system (TTSS) allows for closure of large irregular defects using a gastroscope or colonoscope, without the need for endoscope withdrawal. Since its approval 3 years ago, only a handful of studies have explored outcomes using this novel device. Multiple databases were searched for studies looking at TTSS closure from inception until August 2023. The primary outcomes were the success of TTSS alone and TTSS with clips for complete defect closure. Secondary outcomes included complete closure based on procedure type (endoscopic mucosal resection [EMR], endoscopic submucosal dissection [ESD]) and adverse events. Eight studies met the inclusion criteria (449 patients, mean defect size 34.3 mm). Complete defect closure rates for TTSS alone and TTSS with adjunctive clips were 77.2% (95%CI 66.4-85.3; I2=79%) and 95.2% (95%CI 90.3-97.7; I2=42.5%), respectively. Complete defect closure rates for EMR and ESD were 99.2% (95%CI 94.3-99.9; I2 = 0%) and 92.1% (95%CI 85-96; I2=0%), respectively. The adverse event rate was 5.4% (95%CI 2.7-10.3; I2=55%). TTSS is a novel device for closure of postprocedural defects, with relatively high technical and clinical success rates. Comparative studies of closure devices are needed.

From Basic Science to Clinical Practice: A Review of Current Periodontal/Mucogingival Regenerative Biomaterials.

Periodontitis is a dysbiosis-driven inflammatory disease affecting the tooth-supporting tissues, characterized by their progressive resorption, which can ultimately lead to tooth loss. A step-wise therapeutic approach is employed for periodontitis. After an initial behavioral and non-surgical phase, intra-bony or furcation defects may be amenable to regenerative procedures. This review discusses the regenerative technologies employed for periodontal regeneration, highlighting the current limitations and future research areas. The search, performed on the MEDLINE database, has identified the available biomaterials, including biologicals (autologous platelet concentrates, hydrogels), bone grafts (pure or putty), and membranes. Biologicals and bone grafts have been critically analyzed in terms of composition, mechanism of action, and clinical applications. Although a certain degree of periodontal regeneration is predictable in intra-bony and class II furcation defects, complete defect closure is hardly achieved. Moreover, treating class III furcation defects remains challenging. The key properties required for functional regeneration are discussed, and none of the commercially available biomaterials possess all the ideal characteristics. Therefore, research is needed to promote the advancement of more effective and targeted regenerative therapies for periodontitis. Lastly, improving the design and reporting of clinical studies is suggested by strictly adhering to the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement.

Hemostatic efficacy of a novel self-assembling peptide gel for delayed bleeding following colorectal endoscopic submucosal dissection with complete endoscopic defect closure.

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

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.

Low delayed bleeding and high complete closure rate of mucosal defects with the novel through-the-scope dual-action tissue clip after endoscopic resection of large nonpedunculated colorectal lesions (with video)

Background and AimsComplete closure following endoscopic resection (ER) of large non-pedunculated colorectal lesions (LNPCLs) can reduce delayed bleeding but is challenging with conventional through-the-scope (TTS) clips alone. The novel dual action tissue (DAT) has clip arms that open and close independent of each other, facilitating tissue approximation. We aimed to evaluate the rate of complete closure and delayed bleeding with the DAT clip after ER of LNPCLs. MethodsMulticenter prospective cohort study of all patients who underwent defect closure with the DAT clip following endoscopic mucosal resection (EMR) or submucosal dissection (ESD) of LNPCLs ≥ 20 mm from July 2022 to May 2023. Delayed bleeding was defined as bleeding event requiring hospitalization, blood transfusion or any intervention within 30 days after the procedure. Complete closure was defined as apposition of mucosal defect margins without visible submucosal areas < 3 mm along the closure line. ResultsA total of 107 patients (median age 64 years; 42.5% women) underwent EMR (n=63) or ESD (n=44) of LNPCLs (median size 40 mm; 74.8% right colon) followed by defect closure. Complete closure was achieved in 96.3% (n=103) with a mean of 1.4±0.6 DAT and 2.9±1.8 TTS clips. Delayed bleeding occurred in one patient (0.9%) without requiring additional interventions. ConclusionThe use of the DAT clip in conjunction with TTS clips achieved high complete defect closure after ER of large LNPCLs and was associated with a 0.9% delayed bleeding rate. Future comparative trials and formal cost-analyses are needed to validate these findings.

AESTHETIC REHABILITATION OF SEVERE ANTERIOR ALVEOLAR RIDGE DEFECT WITH ANDREWS BRIDGE-A CASE SERIES

Loss of variable amount of soft and hard tissueis often an inevitable consequence of missing teeth.Prosthetic rehabilitation of large anterior alveolar ridge defects is often a challenge to the clinician.1 Such defects require not just the replacement of teeth, but also closure of defective area so as to achieve proper speech and aesthetics. Fixed removable partial dentures are indicated for patients with extensive tissue loss and when the alignment of opposing arches creates difficulties for placement of conventional partial denture. Andrewss bridge is a type of fixed removable prosthesis indicated in patients with severe ridge defects. This type of prosthesis successfully replaces missing teeth along with complete closure of defect, restoring speech and aesthetics.2.

Https://scholarhub.ui.ac.id/jdi/vol30/iss1/1/

Fenestration term is derived from the Latin word ‘fenestra’ means ‘window’. Gingival fenestration is not found in routine while its actual occurrence is assumed to be higher. Additionally, if these mucogingival defects persist for a longer duration it may lead to adverse outcomes like compromised esthetics, hypersensitivity, plaque and calculus deposition, and susceptibility to dental caries. Present cases of gingival fenestration were successfully treated by using full-thickness flap elevation with connective tissue graft placement. Two cases were presented with the accumulation of plaque and calculus and having gingival fenestration to the respective sites. After phase 1 therapy, full thickness flap was raised and a connective tissue graft was placed beneath the fenestrated area. The successful results were obtained in both cases in terms of complete closure of gingival fenestration defects and well-adapted margins with adjacent tissues at one year of follow-up. Full thickness flap with connective tissue graft procedure resulted in complete closure of gingival fenestration in both cases with no recurrence at one-year follow-up and can be used as a successful and predictable treatment modality for the management of such cases.

A120 ENDOSCOPIC CLOSURE TECHNIQUES FOLLOWING ACUTE IATROGENIC PERFORATION -- AN UPDATED SYSTEMATIC REVIEW

Abstract Background Iatrogenic perforation is arguably the most feared adverse event associated with endoscopy. Current American Society for Gastrointestinal Endoscopy (ASGE) and European Society of Gastroenterology Endoscopy (ESGE) guidelines recommend endoscopic closure as the first-line treatment strategy. Historically, this has been achieved using through-the-scope clips (TTSC). Given the emergence of alternative endoscopic closure techniques including over-the-scope clips (OTSC) and endoscopic suturing, we sought to provide an updated review of the literature. Purpose To review endoscopic closure techniques following iatrogenic perforation during screening or therapeutic endoscopy. Method Based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines, an electronic search of MEDLINE and EMBASE from June 1st, 1946 – Oct 10th, 2022 was performed. Inclusion criteria was limited to English full-text original citations, with case reports, and cohorts with &amp;lt; 3 patients excluded. Our primary objective was to assess complete defect closure after attempted endoscopic treatment. Outcomes were stratified by modality (TTSC, OTSC, endoscopic suturing) and chronologically based on a previous well received systematic review. Result(s) A total of 2549 citations were identified in our electronic search, of which 34 were included representing 830 perforations. Overall, successful endoscopic closure was achieved in 763 cases (91.9%). When stratified by endoscopic closure techniques, range estimates for successful endoscopic closure was 71% – 100%, 57% - 100%, and 100% for TTSC, OTSC and endoscopic suturing respectively. When stratifying chronologically, an improvement in TTSC closure was identified. Conclusion(s) Endoscopic defect closure, including TTSC, OTSC and endoscopic suturing, are effective in the management of iatrogenic perforations with increasing TTSC performance over time. It remains the primary treatment strategy for iatrogenic perforation. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Feasibility and efficacy of endoscopic purse-string suture-assisted closure for mucosal defects induced by endoscopic manipulations.

Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close, although complete closure is recommended for better recovery. Endoscopic purse-string assisted suturing (EPSS) has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects. However, details regarding the efficacy of endoscopic pre-purse-string suture (P-EPSS) are unknown, especially that it offers several advantages over conventional EPSS (C-EPSS). To elucidate the outcomes of EPSS-assisted closure in different clinical situations, and evaluate the efficacy of P-EPSS. This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS (n = 63) or C-EPSS (n = 117) between July 2014 and June 2020. The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size, location, and mor-phology, incidence of complete closure, intraoperative perforation, and delayed adverse events were evaluated. Data on the features and clinical course of cases with adverse events were collected for further analysis. Patients with lesion size larger than 3 cm, lesions located at the fundus of stomach, or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure. The P-EPSS group showed a sign-ificantly higher proportion of intraoperative perforation (56% vs 17%) and a much shorter procedure time (9.06 ± 6.14 min vs 14.84 ± 7.25 min). Among adverse events, the incidence of delayed perforation (5% vs 4%; P = 0.82) and delayed bleeding (3% vs 4%; P = 0.96) did not differ significantly between the groups. Multivariate analysis revealed that lesions with incomplete closure [odds ratio (OR) = 21.33; 95% confidence interval (CI): 5.45-83.45; P < 0.01] or size greater than 3 cm (OR = 3.14; 95%CI: 1.08-9.18; P = 0.039) showed a statistical tendency to result in an increase in delayed adverse events. The present study revealed that EPSS could achieve secure complete closure of mucosal defect. P-EPSS could shorten the procedure and yield complete closure of mucosal defects. Rather than closure-type selection, incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.

Conventional Clips vs Over-the-Scope Clips for Mucosal Defects Closure After Duodenal Endoscopic Submucosal Dissection

Over-the-scope clips (OTSCs) are used for treating gastrointestinal perforations, postoperative anastomotic leakages, and mucosal defect closure after endoscopic resections. However, OTSCs are expensive and associated with fatal complications; therefore, proper OTSC usage is necessary. Criteria of OTSC use for mucosal defect closure after duodenal endoscopic submucosal dissection (ESD) are scarce. We examined closure outcomes with OTSCs and conventional clips in patients undergoing duodenal ESD, analyzed the resected specimen area, estimated the preoperative size of tumors treated with each method, and attempted to clarify the criteria for the use of OTSCs vs conventional clips. Endoscopic resection was performed for 133 superficial duodenal epithelial tumors from April 2017 to February 2022. Complete closure of mucosal defects after duodenal ESD was attempted for 82 superficial non-ampullary duodenal epithelial tumors, divided into OTSC and control (conventional clips used) groups. Closure outcomes were analyzed. The overall rate of complete mucosal defect closure in both groups was 98.8%. Significant between-group differences existed in the median estimated tumor size and median resected specimen area. Conventional clips work well for mucosal defects ≤18 mm after duodenal ESD, but for those >18 mm, a combination of OTSCs may be considered.

Topical Intranasal Insulin Enhances Healing of Nasal Mucosa: An Experimental Animal Study.

Aim of this study was to evaluate the effect of topical intranasal insulin on healing of nasal mucosa in a rat model. Forty-eight Wistar rats, weighing between 250 and 300 g and aged 10-12 weeks were used and randomized into two equal groups. 1.9 mm curette was introduced through the left nostril and 1.9 mm mucosa from the left nasal septum was curetted. Postoperatively, animals in the control group received 1 mL of physiologic saline, 3 times a day in a nasal irrigation fashion. Animals in the experimental group received 1 mL of 5 IU/mL regular insulin in saline solution. Subjects were sacrificed after 5, 10, and 15 days and macroscopic and histomorphometric evaluations were performed. There were no mucosal synechiae and septal perforation macroscopically. Histological examination revealed that the defect size reduction was 21% in the saline group versus 56% in the insulin group on the fifth day (p = 0.006). There was 62% defect reduction in the saline group versus 79% in the insulin group on the 10th day (p = 0.034). On the 15th day, only 67% of saline group animals had complete defect closure, whereas 100% of animals treated with insulin had complete closure (92% vs 100% mucosal defect reduction, p = 0.036). Both edema and inflammation were less in the insulin group on 15th day (p = 0.006; p = 0.023, respectively). The results from this study support the safety and efficacy of topical insulin on wound healing in the literature. This study could guide further experimental studies that examine human sinonasal wound healing.

OC-077 OPEN REPAIR OF FLANK AND LUMBAR HERNIAS (FLH): 145 CONSECUTIVE REPAIRS AT A HIGH-VOLUME, TERTIARY HERNIA CENTER

Abstract Aim FLH present a surgical challenge due to their anatomic location, proximity to boney structures, and lack of elasticity of the surrounding muscle. With less than 1,000 cases reported, there is no uniform operative management. This is the largest study to date evaluating FLH repair (FLHR). Materials &amp; Methods A prospective, single-center, hernia specific database was queried for patients who underwent open flank or lumbar hernia repair from 2004–2021. Demographics, operative characteristics, and outcomes were evaluated. Standard statistical methods were used. Results 145 patients included 109 flank hernias and 36 lumbar hernias. The hernias resulted from prior surgery (73.3%), blunt trauma (19.7%), or primary defects (7.0%). The mean defect size was 125.7±166.8cm2, 46.9% were recurrent, and 11.0% of patients visited a pain specialist preoperatively. Mesh was commonly synthetic (92.4%), a mean of 755.9±373.4 cm2, and placed in the preperitoneal space (92.7%). Component separation technique was utilized in 16.8% of cases and pelvic bone anchor fixation in 13.8%. Preoperative chronic pain was present in 75% of patients receiving bone anchors and only 6.6% postoperatively. Complete defect closure occurred in each case. Wound infection (8.1%) and mesh infection (1.4%) were uncommon. Prolonged, postoperative discomfort was reported in 22%, half of which had chronic pain preoperatively (p&amp;lt;0.01). Hernia recurrence was 3.4% at 29.3±13.2 months follow-up. Recurrences occurred posteriorly in 3 and in 2 mesh infections requiring explantation. Conclusions Open preperitoneal repair of FLHs with synthetic mesh results in low rates of postoperative complications and hernia recurrence. Postoperative pain correlated closely with preoperative pain.

Suturing techniques with endoscopic clips and special devices after endoscopic resection.

Endoscopic submucosal dissection is an established method for complete resection of large and early gastrointestinal tumors. However, methods to reduce bleeding, perforation, and other adverse events after endoscopic resection (ER) have not yet been defined. Mucosal defect closure is often performed endoscopically with a clip. Recently, reopenable clips and large-teeth clips have also been developed. The over-the-scope clip enables complete defect closure by withdrawing the endoscope once and attaching the clip. Other methods involve attaching the clip-line or a ring with an anchor to appose the edges of the mucosal defect, followed by the use of an additional clip for defect closure. Since clips are limited by their grasping force and size, other methods, such as endoloop closure, endoscopic ligation with O-ring closure, and the reopenable clip over-the-line method, have been developed. In recent years, techniques often utilized for full-thickness ER of submucosal tumors have been widely used in full-thickness defect closure. Specialized devices and techniques for defect closure have also been developed, including the curved needle and line, stitches, and an endoscopic tack and suture device. These clips and suture devices are applied for defect closure in emergency endoscopy, accidental perforations, and acute and chronic fistulas. Although endoscopic defect closure with clips has a high success rate, endoscopists need to simplify and promote endoscopic closure techniques to prevent adverse events after ER.

Complete closure of mucosal defect after colonic endoscopic submucosal dissection using clip with a silicone traction band.

Complete closure of mucosal defect after colonic endoscopic submucosal dissection using clip with a silicone traction band.