SOCPS with direct visualization and biopsy for diagnosis and SOCPS-directed therapy for biliary and pancreatic diseases can be safely performed with a high success rate. The clinical trial was registered at UMIN CTR (http://www.umin.ac.jp). The registration identification number is UMIN000015155.

In recent years, due to the increasing prevalence of upper gastrointestinal endoscopy, there have been an increasing number of reports on duodenal adenoma and early stage cancer. However, endoscopic techniques for the resection of duodenal adenomas are difficult, due to the anatomical features of the duodenum, and the long distance to the lesion. There have only been a few reports on the use of endoscopic techniques for duodenal adenomas compared to those focused on the stomach and large intestine. For duodenal adenomas, we used a conventional endoscope for lesions proximal to the major duodenal papilla, and a short-type double balloon endoscope for lesions distal to the papilla. The en-bloc resection rate was 93.8%. There was only one case of microperforation. Endoscopic manipulation is considered difficult in the deep areas of the duodenum, but double balloon endoscopy enabled stable manipulation and successful resection of the tumor in the majority of cases.

Endoscopic mucosal resection has been recognized as a standard method for treating mucosal tumors of the stomach in Japan. In our department, we have treated mucosal defects after this procedure by using metallic clips to prevent and manage complications related to endoscopic mucosal resection. In the present study, we explain the new technique, the ‘loop‐and‐clips’ method, which uses clips and a detachable snare to close large mucosal defects after endoscopic mucosal resection.

Background: Representative complications of endoscopic mucosal resection to treat intramural gastric tumors include bleeding and perforation. The purpose of the present study was to clarify whether endoscopic closure of mucosal defects using metallic clips decreases the incidence of delayed bleeding following endoscopic mucosal resection. Patients and Methods: The records of 187 intramural tumors of the stomach in the 181 patients that were treated by endoscopic mucosal resection between 1992 and 2001 were reviewed retrospectively. The patients were classified into two groups. The first group included patients who received endoscopic mucosal resection but were not treated by endoscopic mucosal closure. The second group included patients who were treated with endoscopic mucosal closure using metallic clips after endoscopic mucosal resection. The incidences of delayed bleeding following endoscopic mucosal resection in these two groups were evaluated. Results: Delayed bleeding following endoscopic mucosal resection was observed in 13 of 96 (13.5%) of the lesions of the first group. Delayed bleeding was encountered in only two of 91 (2.2%) lesions of the second group. Conclusions: Endoscopic closure of mucosal defects with metallic clips after endoscopic mucosal resection in gastric lesions was useful in decreasing the incidence of delayed bleeding following endoscopic mucosal resection.Key words: endoscopic closure, endoscopic mucosal resection, endoscopic suture, intramural tumor of the stomach, metallic clip.

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