New Closure Method Using Loop and Open–Close Clips after Endoscopic Submucosal Dissection of Stomach and Colon Lesions

Abstract

Endoscopic submucosal dissection (ESD) and en bloc resection of stomach and colon tumors have become common. However, mucosal defects resulting from ESD may cause delayed bleeding and perforation. To prevent adverse events, we developed a new clip closure technique, namely, the loop and open–close clip closure method (LOCCM), and aimed to examine its efficacy after ESD for stomach and colon tumors. The LOCCM uses loop and open–close clips. Here, the open–close clip was used to grasp the loop to bring it to the edge of the post-ESD mucosal defect. Another clip with a loop was then inserted into the opposite edge and clipped to the contralateral mucosa to pull both edges together. Once apposed, additional clips facilitated complete closure. The LOCCM was performed in 19 patients after ESD at Tottori University between October 2020 and March 2021. The outcomes retrospectively analyzed were the LOCCM success and adverse event rates. The complete closure rate using LOCCM was 89.5% and none of the patients had post-ESD bleeding or perforation. The results show that LOCCM is an effective and safe closure technique for mucosal defects after stomach and colon ESD to prevent bleeding and perforation.

Endoscopic Delivery of Polymers Reduces Delayed Bleeding after Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis

“…Of the total, 54 proved potentially relevant for full-text review. Of these, 31 articles on the management of ESD-induced ulcers via endoscopic closure (hemoclips, endoclips, endoloop + endoclips, detachable snare + clips, OTSC + through-the-scope clips [TTSC], overstitch suturing, handsewn suturing) [31][32][33][34][35][36][37][38][39][40][41][42], tissue shielding methods (PGA sheets-based) [10,[43][44][45][46][47][48][49], and hemostatic powder/gel spray [18,19,[50][51][52][53][54][55][56][57][58], matched the selection criteria and were included in the systematic review. The key characteristics of each included study appear in Table 1.…”

Clip–Detector Using a Neodymium Magnet to Locate Malignant Tumors during Laparoscopic Surgery

“…Furthermore, autologous blood localization is difficult and time-consuming, which makes this method economically disadvantageous. To overcome these disadvantages, techniques for locating a tumor using a sensor that can detect a clip are being studied [ 11 , 12 , 13 , 14 , 15 , 16 ]. More specifically, a clip is attached to the tumor site, and research is underway on a method for locating this clip using a sensor, thereby locating the tumor that needs resection.…”

“…Radio frequency identification (RFID) [ 11 ] and the open–close clip closure method [ 14 ] have the advantage of being able to simultaneously detect tumors in the stomach and colon. In addition, the clip and the sensor are integrated to ensure robustness.…”

“…In addition, the clip and the sensor are integrated to ensure robustness. However, the RFID method [ 11 ] requires 40.5 and 38.4 s to detect a tumor in the stomach and colon, respectively, and the open–close clip closure method [ 14 ] has a relatively long time as 24.9 and 18.7 s, respectively, for detecting tumors in the stomach and colon.…”

“…In addition, only tumors in the colon can be detected, and the time required for tumor detection is 456, 342, and 15–90 s, respectively. The characteristic of [ 11 , 12 , 13 , 14 , 15 , 16 ] is that the time required to detect a tumor exceeds 5 s; therefore, these technologies are unsuitable for use in the operating room. To overcome these shortcomings, a sensor capable of locating a tumor in the stomach and colon simultaneously and accurately is required.…”