Advertisement

Feasibility of a new ligation using the double-loop clips technique without an adhesive agent for ulceration after endoscopic submucosal dissection of the colon (with video)

Published:February 19, 2020DOI:https://doi.org/10.1016/j.gie.2020.02.015

      Background and Aims

      Several ligation techniques for ulceration after endoscopic submucosal dissection (ESD) have been reported, but none have been established for clinical use because of technical complexity and the need for expensive equipment. Therefore, the technical feasibility of a new ligation method using the double-loop clips (D-L clips) technique without an adhesive agent for ulceration after ESD of the colon was assessed.

      Methods

      Among 35 patients who underwent ESD of the colon in Kushiro Rosai Hospital between April 2019 and September 2019, 26 patients who underwent ligation using the D-L clips technique for the post-ESD ulcer bed were included in this retrospective study. Continuation or cessation of antithrombotic agents was based on the Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment.

      Results

      The rate of en bloc R0 resection was 97.1%, the median length of the resected specimen was 3.2 cm (interquartile range [IQR], 2.8-3.8 cm), and the complete ligation rate was 88.5% (23 of 26). Excluding patients with lesion sites in the rectum below the peritoneal reflection, the complete ligation rate was 95.5% (21 of 22). The median duration of the ligation procedure was 20 minutes (IQR, 16-24 minutes). The only delayed procedural adverse event was post-ESD coagulation syndrome in 1 patient. Incomplete ligation was significantly more frequent in patients with lesion sites in the inferior rectal valve/anal verge area (P = .0269).

      Conclusions

      Ligation using the D-L clips technique without an adhesive agent is feasible for closing ulceration after ESD of the colon, whereas other techniques may be necessary for lesions in the rectum below the peritoneal reflection.

      Graphical abstract

      Abbreviations:

      D-L clips (Double-loop clips), ESCS (endoscopic string clip suturing), ESD (endoscopic submucosal dissection), IQR (interquartile range), LACC (line-assisted complete closure), PECS (post-ESD electrocoagulation syndrome)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Zhang Q.S.
        • Han B.
        • Xu J.H.
        • et al.
        Clip closure of defect after endoscopic resection in patients with larger colorectal tumors decreased the adverse events.
        Gastrointest Endosc. 2015; 82: 904-909
        • Kantsevoy S.V.
        • Bitner M.
        • Mitrakov A.A.
        • et al.
        Endoscopic suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible, fast, and eliminates the need for hospitalization (with videos).
        Gastrointest Endosc. 2014; 79: 503-507
        • Fujihara S.
        • Mori H.
        • Kobara H.
        • et al.
        The efficacy and safety of prophylactic closure for a large mucosal defect after colorectal endoscopic submucosal dissection.
        Oncol Rep. 2013; 30: 85-90
        • Oka S.
        • Tanaka S.
        • Kanao H.
        • et al.
        Current status in the occurrence of postoperative bleeding, perforation and residual/local recurrence during colonoscopic treatment in Japan.
        Dig Endosc. 2010; 22: 376-380
        • Harada H.
        • Suehiro S.
        • Murakami D.
        • et al.
        Clinical impact of prophylactic clip closure of mucosal defects after colorectal endoscopic submucosal dissection.
        Endosc Int Open. 2017; 5: E1165-E1171
        • Sakamoto N.
        • Beppu K.
        • Matsumoto K.
        • et al.
        "Loop Clip," a new closure device for large mucosal defects after EMR and ESD.
        Endoscopy. 2008; 40: E97-E98
        • Mori H.
        • Kobara H.
        • Nishiyama N.
        • et al.
        Simple but reliable endoscopic sliding closure with ring-shaped surgical thread after endoscopic submucosal dissection.
        Endoscopy. 2015; 47: E428-E429
        • Nomura T.
        • Matsuzaki I.
        • Sugimoto S.
        • et al.
        Clip-on-clip closure method for a mucosal defect after colorectal endoscopic submucosal dissection: a prospective feasibility study.
        Surg Endosc. 2020; 34: 1412-1416
        • Horii T.
        • Ikehara H.
        • Gotoda T.
        Endoscopic closure method using a dental floss O-ring for mucosal defect after endoscopic resection.
        Dig Endosc. 2019; 31: e15
        • Akimoto T.
        • Goto O.
        • Nishizawa T.
        • et al.
        Endoscopic closure after intraluminal surgery.
        Dig Endosc. 2017; 29: 547-558
        • Abiko S.
        • Yoshikawa A.
        • Harada K.
        • et al.
        New ligation technique using a double loop clip without adhesive for ulceration following endoscopic submucosal dissection of the colon.
        Endoscopy. 2020; 52: E20-E21
        • Ohata K.
        • Muramoto T.
        • Minato Y.
        • et al.
        Usefulness of a multifunctional snare designed for colorectal hybrid endoscopic submucosal dissection (with video).
        Endosc Int Open. 2018; 6: E249-E253
        • Yamashina T.
        • Takeuchi Y.
        • Uedo N.
        • et al.
        Features of electrocoagulation syndrome after endoscopic submucosal dissection for colorectal neoplasm.
        J Gastroenterol Hepatol. 2016; 31: 615-620
        • Tajiri H.
        • Kitano S.
        Complication associated with endoscopic mucosal resection: definition of bleeding that can be viewed as accidental.
        Dig Endosc. 2004; 16: 134-136
        • Fujimoto K.
        • Fujishiro M.
        • Kato M.
        • et al.
        Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment.
        Dig Endosc. 2014; 26: 1-14
        • Kato M.
        • Uedo N.
        • Hokimoto S.
        • et al.
        Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment: 2017 appendix on anticoagulants including direct oral anticoagulants.
        Dig Endosc. 2018; 30: 433-440
        • Sudo G.
        • Tanuma T.
        • Suzuki Y.
        • et al.
        Multiloop method for traction during colorectal endoscopic submucosal dissection.
        VideoGIE. 2019; 4: 11-13
        • Kanda Y.
        Investigation of the freely available easy-to-use software 'EZR' for medical statistics.
        Bone Marrow Transplant. 2013; 48: 452-458
        • Boronow K.E.
        • Brody J.G.
        • Schaider L.A.
        • et al.
        Serum concentrations of PFASs and exposure-related behaviors in African American and non-Hispanic white women.
        J Expo Sci Environ Epidemiol. 2019; 29: 206-217
        • Yahagi N.
        • Nishizawa T.
        • Akimoto T.
        • et al.
        New endoscopic suturing method: string clip suturing method.
        Gastrointest Endosc. 2016; 84: 1064-1065
        • Yamasaki Y.
        • Takeuchi Y.
        • Uedo N.
        • et al.
        Line-assisted complete closure of duodenal mucosal defects after underwater endoscopic mucosal resection.
        Endoscopy. 2017; 49: E37-E38
        • Nishizawa T.
        • Akimoto T.
        • Uraoka T.
        • et al.
        Endoscopic string clip suturing method: a prospective pilot study (with video).
        Gastrointest Endosc. 2018; 87: 1074-1078
        • Yamasaki Y.
        • Takeuchi Y.
        • Iwatsubo T.
        • et al.
        Line-assisted complete closure for a large mucosal defect after colorectal endoscopic submucosal dissection decreased post-electrocoagulation syndrome.
        Dig Endosc. 2018; 30: 633-641
        • Yamasaki Y.
        • Harada K.
        • Oka S.
        • et al.
        Feasibility of underwater clip closure for large mucosal defects after colorectal endoscopic submucosal dissection.
        Digestion. 2019; 99: 327-332
        • Nishizawa T.
        • Banno S.
        • Kinoshita S.
        • et al.
        Feasibility of endoscopic mucosa-submucosa clip closure method (with video).
        Endosc Int Open. 2018; 6: E1070-E1074