Reopenable clip‐over‐the‐line method for closing large mucosal defects following gastric endoscopic submucosal dissection: Prospective feasibility study

Abstract

Objectives Large mucosal defects following gastric endoscopic submucosal dissection (ESD) cause postoperative bleeding. To address this limitation and ensure closure of large mucosal defects, we developed the reopenable clip‐over‐the‐line method (ROLM) using a reopenable clip and nylon line. The purpose of this study was to evaluate the feasibility of the ROLM for closure of large mucosal defects following gastric ESD in a prospective, consecutive series of cases. Methods We performed the ROLM on 50 consecutive patients with gastric mucosal defects at the Ise Red Cross Hospital and Mie Prefectural Shima Hospital. The time to complete the ROLM, numbers of clips and lines required, size of defect, and closure success rate were measured, and postoperative adverse events were recorded. Results In all, 50 lesions were included in this study period between July 2021 and March 2022. The success rates of defect closure and defect closure without submucosal dead space of the ROLM were both 100% (50/50), with a median ROLM time of 30 (range, 14–35) min and a median resected specimen major axis of 45 (range, 31–73) mm. The median number of reopenable clips used was 31 (range, 10–93). Following gastric ESD, two cases of post‐ESD bleeding were observed during the follow‐up periods. Conclusion Our results suggest that ROLM is a feasible strategy for complete closure of mucosal defects post‐ESD without submucosal dead space. Future comparative studies with post‐ESD bleeding rate as the main outcome are desirable to evaluate the efficacy of ROLM.

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

“…With ROLM, the first deep colon closure will be difficult for a beginner. We had previously carried out a prospective study of 50 consecutive cases of mucosal defect closure after gastric ESD [21]. During that time, we identified several technical improvements that enable proper ROLM implementation.…”

Twin‐grasper assisted mucosal inverted closure achieves complete healing of large perforations after gastric endoscopic full‐thickness resection

“…4) or when the mucosa epithelial, rather than the muscularis mucosae, were put in apposition by endoloops, 13 O-ring, 14 Loop 9, 15 or reopenable clip over line method. 16,17 So, it is quite important to adjust the TTSC and make sure both sides of the mucosa are in an inverted apposition. The degree of neovascularity and fibroblasts in the submucosa was also found smaller in the inverted healing sites than that in the ulcer healing groups, which is similar with results in hand-suturing closure.…”

“…These two strengths prevented the mucosa from slipping and provided better condition for mucosal healing, especially the continuity of the muscularis mucosae, which was disappeared in the ulcer healing (Fig. 4) or when the mucosa epithelial, rather than the muscularis mucosae, were put in apposition by endoloops, 13 O‐ring, 14 Loop 9, 15 or reopenable clip over line method 16,17 . So, it is quite important to adjust the TTSC and make sure both sides of the mucosa are in an inverted apposition.…”

Closure of full-thickness perforation following endoscopic submucosal dissection of a gastric tumor near an anastomosis, using the reopenable clip-over-line method

“…We have developed a closure technique using reopenable clips with a hole in one jaw (or “arm”) of the clip (Sureclip 8 mm; Micro-Tech, China) and a line (nylon, 0.22 mm) that allows complete closure of thick mucosa and muscle layers, such as those in the stomach. We have previously described the reopenable clip-over-line (RCOL) technique 2 3 . In this report, we present complete defect closure using the RCOL method after perforation during ESD at a gastric anastomosis.…”