Rubber band-assisted closure of a mucosal defect following duodenal EMR

Abstract

EMR of large duodenal adenomas is a technically challenging procedure. It carries a particularly high risk of perforation (5 % -10%) because of its relatively thin and fixed wall and delayed bleeding (15%) due to its rich vascular supply. 1 Systematic closure of mucosal defects after duodenal endoscopic resection has been found to significantly reduce the risk of delayed adverse events (AEs) by 80%, specifically the risk of delayed bleeding and perforation. 2 However, owing to the fixed retroperitoneal descending duodenum, apposition of the 2 mucosal edges is not always feasible, making closure using standard clips challenging. We describe a simple and safe technique using an inexpensive and widely available rubber band and standard endoscopic clips (Video 1, available online at www.giejournal.org). TECHNIQUEThis technique requires the use of a commercially available orthodontic rubber band (Fig. 1A) in addition to Figure 1. A, Rubber band used for closure. B, Rubber band is placed on 1 clip arm. C, Clip is closed securely. D, Clip with the attached rubber band is inserted into the endoscope instrument channel.