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Clip-on-clip closure method for a mucosal defect after colorectal endoscopic submucosal dissection: a prospective feasibility study

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Abstract

Background

The closure of mucosal defects after colorectal endoscopic submucosal dissection (ESD) remains difficult. Therefore, various methods and devices have been developed to aid in this procedure. However, a standard method for mucosal defect closure after ESD has not been established. We aimed to examine the efficiency and safety of our clip-on-clip closure method (CCCM) after colorectal ESD.

Methods

The CCCM is a novel method for colorectal mucosal defect closure that uses a conventional clip on the handle of another clip, with the gap as an anchor. The CCCM was prospectively used for closing mucosal defects in 30 patients with 32 lesions after colorectal ESD at the Japanese Ise Red Cross Hospital, Yokkaichi Municipal Hospital, and Medical Corporation Yamashita Hospital between March 2018 and July 2018. Outcome measures were closure success rates of CCCM, procedural closure time, and postoperative adverse events.

Results

The median resected specimen size was 34 mm (range 28–73 mm) and the median CCCM defect closure success rate was 97% (31/32). The median procedural time was 8 min (range 3.5–29.2 min), and the median number of clips used was 12 pieces (range 5–20). None of the patients had postoperative adverse events.

Conclusions

CCCM is an efficient, safe, and simple method for the closure of mucosal defects after colorectal ESD that can be performed using only conventional clips.

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References

  1. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 8:225–229

    Article  Google Scholar 

  2. Oyama T, Tomori A, Hotta K, Morita S, Kominato K, Tanaka M, Miyata Y (2005) Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 3:67–70

    Article  Google Scholar 

  3. Yahagi N, Uraoka T, Ida Y, Hosoe N, Nakamura R, Kitagawa Y, Ogata H, Hibi T (2011) Endoscopic submucosal dissection using the Flex and the Dual knives. Tech Gastroint Endosc 13:74–78

    Article  Google Scholar 

  4. Saito Y, Uraoka T, Yamaguchi Y, Hotta K, Sakamoto N, Ikematsu H, Fukuzawa M, Kobayashi N, Nasu J, Michida T, Yoshida S (2010) A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 72:1217–1225

    Article  Google Scholar 

  5. Puli SR, Kakugawa Y, Saito Y, Antillon D, Gotoda T, Antillon MR (2009) Successful complete cure en-bloc resection of large nonpedunculated colonic polyps by endoscopic submucosal dissection: a meta-analysis and systematic review. Ann Surg Oncol 16:2147–2151

    Article  Google Scholar 

  6. Takeuchi Y, Iishi H, Tanaka S, Saito Y, Ikematsu H, Kudo SE, Sano Y, Hisabe T, Yahagi N, Saitoh Y, Igarashi M (2014) Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort. Int J Colorectal Dis 29:1275–1284

    Article  Google Scholar 

  7. Pohl H, Grimm IS, Moyer MT, Hasan MK, Pleskow D, Elmunzer BJ, Khashab MA, Sanaei O, Al-Kawas FH, Gordon SR, Mathew A (2019) Clip closure prevents bleeding after endoscopic resection of large colon polyps in a randomized trial. Gastroenterology 157:977–984

    Article  Google Scholar 

  8. Zhang QS, Han B, Xu JH, Gao P, Shen YC (2015) Clip closure of defect after endoscopic resection in patients with larger colorectal tumors decreased the adverse events. Gastrointest Endosc 82:904–909

    Article  Google Scholar 

  9. Fujihara S, Mori H, Kobara H, Nishiyama N, Kobayashi M, Rafiq K, Masaki T (2013) The efficacy and safety of prophylactic closure for a large mucosal defect after colorectal endoscopic submucosal dissection. Oncol Rep 30:85–90

    Article  Google Scholar 

  10. Liaquat H, Rohn E, Rex DK (2013) Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions. Gastrointest Endosc 77:401–407

    Article  Google Scholar 

  11. Yamasaki Y, Takeuchi Y, Iwatsubo T, Kato M, Hamada K, Tonai Y, Matsuura N, Kanesaka T, Yamashina T, Arao M, Suzuki S (2018) Line-assisted complete closure for a large mucosal defect after colorectal endoscopic submucosal dissection decreased post-electrocoagulation syndrome. Dig Endosc 30:633–641

    Article  Google Scholar 

  12. Yoshikane H, Hidano H, Sakakibara A, Niwa Y, Goto H (2000) Feasibility study on endoscopic suture with the combination of a distal attachment and a rotatable clip for complications of endoscopic resection in the large intestine. Endoscopy 32:477–480

    Article  CAS  Google Scholar 

  13. von Renteln D, Vassiliou MC, Rothstein RI (2009) Randomized controlled trial comparing endoscopic clips and over-the-scope clips for closure of natural orifice transluminal endoscopic surgery gastrotomies. Endoscopy 41:1056–1061

    Article  Google Scholar 

  14. Matsuda T, Fujii T, Emura F, Kozu T, Saito Y, Ikematsu H, Saito D (2004) Complete closure of a large defect after EMR of a lateral spreading colorectal tumor when using a two-channel colonoscope. Gastrointest Endosc 60:836–838

    Article  Google Scholar 

  15. Fujii T, Ono A, Fu KI (2007) A novel endoscopic suturing technique using a specially designed so called 8 ring in combination with resolution clips (with videos). Gastrointest Endosc 66:1215–1220

    Article  Google Scholar 

  16. Sakamoto N, Beppu K, Matsumoto K, Shibuya T, Osada T, Mori H, Shimada Y, Konno A, Kurosawa A, Nagahara A, Otaka M (2008) “Loop Clip”, a new closure device for large mucosal defects after EMR and ESD. Endoscopy 40:E97–E98

    Article  Google Scholar 

  17. Otake Y, Saito Y, Sakamoto T, Aoki T, Nakajima T, Toyoshima N, Matsuda T, Ono H (2012) New closure technique for large mucosal defects after endoscopic submucosal dissection of colorectal tumors (with video). Gastrointest Endosc 75:663–667

    Article  Google Scholar 

  18. Akimoto T, Goto O, Sasaki M, Ochiai Y, Maehata T, Fujimoto A, Nishizawa T, Yahagi N (2016) “Hold-and-drag” closure technique using repositionable clips for large mucosal defects after colonic endoscopic submucosal dissection. Endosc Int Open 4:E1068–E1072

    Article  Google Scholar 

  19. Nishizawa T, Akimoto T, Uraoka T, Mitsunaga Y, Maehata T, Ochiai Y, Fujimoto A, Goto O, Kanai T, Yahagi N (2017) Endoscopic knot clip suturing method—a prospective pilot study (with video). Gastrointest Endosc 85:433–437

    Article  Google Scholar 

  20. Kato M, TakeuchiY Yamasaki Y (2016) Line assisted complete closure of a large colorectal mucosal defect after endoscopic submucosal dissection. Dig Endosc 28:686

    Article  Google Scholar 

  21. Nomura T, Kamei A, Sugimoto S, Oyamada J (2018) New closure method for a mucosal defect after endoscopic submucosal dissection—the clip-on-clip closure method. Endoscopy 50:547–548

    Article  Google Scholar 

  22. Kato M, Takeuchi Y, Yamasaki Y, Arao M, Suzuki S, Iwatsubo T, Hamada K, Tonai Y, Shichijo S, Matsuura N, Nakahira H (2017) Technical feasibility of line-assisted complete closure technique for large mucosal defects after colorectal endoscopic submucosal dissection. Endosc Int Open 5:E11–E16

    Article  Google Scholar 

  23. Mori H, Sakamoto N, Osada T, Ritsuno H, Hidaka Y, Nakae K, Matsumoto K, Beppu K, Shibuya T, Yoshizawa T, Nagahara A (2011) The Loopclip is useful for closing large mucosal defects after colorectal endoscopic submucosal dissection: a preliminary clinical study. Dig Endosc 23:330–331

    Article  Google Scholar 

  24. Kantsevoy SV, Bitner M, Mitrakov AA, Thuluvath PJ (2014) 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 79:503–507

    Article  Google Scholar 

  25. Ohya T, Ohata K, Sumiyama K, Tsuji Y, Koba I, Matsuhashi N, Tajiri H (2009) Balloon overtube-guided colorectal endoscopic submucosal dissection. World J Gastroenterol 15:6086–6090

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Kinan Hospital, 4750 Atawa, Mihama-cho, Minamimuro-Gun, Mie, 519-5293, Japan

    Tatsuma Nomura

  2. Department of Gastroenterology, Ise Red Cross Hospital, Ise, Mie, Japan

    Tatsuma Nomura, Shinya Sugimoto, Jun Oyamda & Akira Kamei

  3. Department of Gastroenterology, Yamashita Hospital, Ichinomiya, Aichi, Japan

    Ippei Matsuzaki

  4. Department of Gastroenterology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan

    Makoto Kobayashi

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  1. Tatsuma Nomura
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  2. Ippei Matsuzaki
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  3. Shinya Sugimoto
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  4. Jun Oyamda
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  5. Akira Kamei
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  6. Makoto Kobayashi
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Correspondence to Tatsuma Nomura.

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Disclosure

Drs. Tatsuma Nomura, Ippei Matsuzaki, Shinya Sugimoto, Jun Oyamda, Akira Kamei, and Makoto Kobayashi have no conflicts of interest or financial ties to disclose.

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Video 1: A scheme and an example of CCCM after colorectal ESD

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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 34, 1412–1416 (2020). https://doi.org/10.1007/s00464-019-07195-x

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  • DOI: https://doi.org/10.1007/s00464-019-07195-x

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