Endoscopic slip-knot clip suturing method: prospective pilot study (with video)

Nishizawa, Toshihiro; Ochiai, Yasutoshi; Uraoka, Toshio; Akimoto, Teppei; Mitsunaga, Yutaka; Goto, Osamu; Fujimoto, Ai; Maehata, Tadateru; Kanai, Takanori; Yahagi, Naohisa

doi:10.1016/j.gie.2016.07.047

Cited by 27 publications

(21 citation statements)

References 15 publications

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“…Wang et al reported that mean procedure time was 13.5 minutes (range 8 – 20) for endoscopic purse-string suture 23 . We previously reported that mean procedure time was 18.2 ± 3.3 minutes for “slip knot clip suturing method” 17 , and 23.4 ± 13.8 minutes for “string clip suturing method” 19 . String-assisted closure techniques sometimes are stuck by a tangle of the string.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of endoscopic mucosa-submucosa clip closure method (with video)

et al. 2018

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Background and study aims We developed a new endoscopic closure technique using just conventional endoclips. The feasibility of endoscopic mucosa-submucosa clip closure method was evaluated in this clinical pilot study. Patients and methods This study involved consecutive 25 patients who underwent colorectal endoscopic submucosal dissection. Endoclips were placed at the edge of the mucosal defect. Each arm of the endoclip gripped the mucosa and submucosa, respectively. The direction in which the endoclip grips were placed was parallel to the short axis of the defect. Several endoclips were applied in this way. As a result, the mucosal defect was significantly reduced in size. Additional clips were placed to achieve complete closure. Results Mean size of resected specimen was 31.2 ± 11 mm. The success rate was 96 % (24/25). Mean procedure time was 9.6 ± 4.4 minutes. Mean number of endoclips was 9.3 ± 3.7. No complications were observed in any of the patients after the procedure. Conclusion Endoscopic mucosa-submucosa clip closure method could close mucosal defect of size around 2 – 4 cm completely using just conventional endoclips, and it seems easy, simple and low cost.

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Section: Discussionmentioning

confidence: 99%

“…Several useful methods have been reported such as endoscopic purse-string suture 14 , slip knot clip suturing method 15 16 17 , string clip suturing method 18 19 , and “loop clip” 20 . However, these methods need endo-loop, double-channel endoscope, string, or supplement devices.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of endoscopic mucosa-submucosa clip closure method (with video)

et al. 2018

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“…abdominal pain in patients without intraoperative perforation. Delayed bleeding was defined as bleeding symptoms or hemoglobin loss (≥ 2 g/dL) [18]. Abdominal pain was defined as sustained spontaneous pain or regional rebound tenderness after ESD.…”

Section: Evaluation Of the Proceduresmentioning

confidence: 99%

Complete closure versus simple closure for perforations during colorectal endoscopic submucosal dissection

et al. 2020

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Background and study aims The efficacy of complete closure versus simple closure for perforations during endoscopic submucosal dissection (ESD) has never been evaluated. We evaluated the efficacy of complete closure and simple closure for perforations and muscular layer injuries incurred during ESD. Patients and methods Thirty-four consecutive patients who underwent “complete closure” or “simple closure” for correction of perforations and muscular layer injuries during colorectal ESD were enrolled in this study. Complete closure was performed by the mucosa-submucosa clip closure method using only conventional endo-clips. For simple closure, endo-clips are placed just for perforation or muscular layer injury, while leaving any mucosal defects open. Results Among the 15 patients in the complete closure group, eight developed perforations and seven developed muscular layer injuries. Among the 19 patients in the simple closure group, six developed perforations and 13 developed muscular layer injuries during the ESD procedure. There were no statistically significant differences between the two groups in inflammatory reactions, adverse events, or length of the hospital stay. Conclusion Complete closure and simple closure for perforations and muscular layer injuries during ESD seem to have similar efficacy. While simple closure for a perforation during ESD seems sufficient, further study will be required to confirm our results.

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“…Recently, feasibility of a closure method using a specially tied string, which is called the slip knot, was reported . A slip‐knot loop hooked to the first clip is delivered through a working channel of the endoscope and placed on one mucosal edge followed by placing the second clip on the other side of the edge and hooking the loop (Fig.…”

Section: Endoscopic Mucosal Closurementioning

confidence: 99%

Endoscopic closure after intraluminal surgery

Akimoto

Goto

Nishizawa

et al. 2017

Digestive Endoscopy

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Endoscopic submucosal dissection is established as a curative endoscopic method for gastrointestinal epithelial neoplasms with a high possibility of complete en bloc resection; however, postoperative adverse events of bleeding and delayed perforation remain. To prevent or minimize them, several techniques for endoscopic mucosal closure have been introduced, such as using endoscopic clips, combined use of hemoclips and supplement devices, and specially designed endoscopic suturing devices. Furthermore, endoscopic full-thickness suturing technique for gastrointestinal wall defect has been developed based on the concept in natural orifice transluminal endoscopic surgery and endoscopic full-thickness resection. Several closure techniques, including over-the-scope clip, threaded bars inserted in a hollow needle, stitches or staplers, and a curved needle and thread are reported. Secure closure of the iatrogenic defect may further expand the range of therapeutic endoscopy. Accumulation of evidence for the efficacy of endoscopic closure and establishment of these techniques are desired.

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Endoscopic slip-knot clip suturing method: prospective pilot study (with video)

Cited by 27 publications

References 15 publications

Feasibility of endoscopic mucosa-submucosa clip closure method (with video)

Feasibility of endoscopic mucosa-submucosa clip closure method (with video)

Complete closure versus simple closure for perforations during colorectal endoscopic submucosal dissection

Endoscopic closure after intraluminal surgery

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