The endoscopic suture method using an endoloop and several clips requires a double-channel endoscope, which is not always available. We have previously developed a suturing technique with a slip knot string and clips for the single-channel endoscope. This report describes a simpler suturing method using a clip with string. In the string clip suturing method, a clip with string (braided polyester, USP 3-0, Natsume Seisakusho Co Ltd, Bunkyo-ku, Japan) is placed at the distal margin of the mucosal defect, followed by insertion of an additional clip to anchor the string at another side of the margin. The clip and string can be passed through the instrument channel (3.2 mm) of the single-channel endoscope. Both sides of the mucosal defect can be gathered by pulling the free end of the string. Additional endoscopic clips are placed to achieve complete closure. Good string traction can change the field of vision from a side view to a front view (Fig. 1; Video 1, available online at www.giejournal.org). This method is simpler than the slip knot clip suturing method and makes it easy to close a large mucosal defect completely by use of a single-channel endoscope.
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Published online: June 17, 2016Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Copyright © 2016 by the American Society for Gastrointestinal Endoscopy
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- Potential problems in performing endoscopic string clip suturingGastrointestinal EndoscopyVol. 93Issue 3
- PreviewWe read with interest the article by Yahagi et al1 on endoscopic string clip suturing (ESCS). ESCS is a useful suturing method. However, we previously experienced an unexpected issue with the ESCS method. The thread used for ESCS got caught between the blades of the loop cutter and could not be cut (Fig. 1). This issue may be difficult to resolve in the proximal colon.2