Modified double layered suturing for a mucosal defect after colorectal endoscopic submucosal dissection (Origami method)

Published:January 12, 2023DOI:
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      Background and Aims

      Through-the-scope clips (TTSC) are among the most common devices used to close colorectal post-endoscopic submucosal dissection (ESD) defects. Although TTSC is easy to deliver, even to the proximal colon, simple clipping of large defects results in mucosa-mucosa closure, which could be unreliable. We developed a novel endoscopic closure technique, modified double-layered suturing, called the origami method (OGM). This method closes not only the mucosal layer but also the muscle layer with only TTSC, which can obtain robust closure even for large defects. This study aimed to evaluate the feasibility of this new closure method for colorectal post-ESD defects.


      This retrospective observational study was conducted at a tertiary care hospital. We reviewed the cases of OGM attempted after colorectal ESD at our institute between October 2021 and October 2022, and measured the clinical characteristics and outcomes of enrolled cases.


      The OGM was attempted in 47 cases after colorectal ESD. Thirty-one cases (66%) were in the proximal colon; five (11%) in the distal colon; six (13%) in the upper rectum; and five (10%) in the lower rectum. The median defect size was 38 mm, the largest being 85 mm. Complete closure was achieved in 44 cases (94%), including all lower rectum cases. There were no perforations caused by clips during closure, and delayed perforation and bleeding were not observed.


      This new closure method is feasible and recommended. The OGM could achieve reliable closure of large defects in any location, including the proximal colon and thick-walled lower rectum, using only TTSC.


      ESD (endoscopic submucosal dissection), PECS (post-endoscopic submucosal dissection coagulation syndrome), TTSC (through-the-scope clips), OGM (origami method)
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