Background and Aims
Through-the-scope clips (TTSCs) are among the most common devices used to close colorectal
post–endoscopic submucosal dissection (ESD) defects. Although TTSCs are 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
using a modified double-layered suturing called the origami method (OGM). This method
closes not only the mucosal layer but also the muscle layer with only TTSCs, 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.
Methods
This retrospective observational study was conducted at a tertiary care hospital.
We reviewed the cases of the OGM attempted after colorectal ESD at our institute between
October 2021 and October 2022 and measured the clinical characteristics and outcomes
of enrolled cases.
Results
The OGM was attempted in 47 cases after colorectal ESD. Thirty-one cases (66%) were
in the proximal colon, 5 (11%) in the distal colon, 6 (13%) in the upper rectum, and
5 (10%) in the lower rectum. The median defect size was 38 mm, with the largest being
85 mm. Complete closure was achieved in 44 cases (94%), including all lower rectum
cases. No perforations were caused by clips during closure, and delayed perforation
and bleeding were not observed.
Conclusions
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 TTSCs.
Abbreviations:
ESD (endoscopic submucosal dissection), OGM (origami method), PECS (post–endoscopic submucosal dissection coagulation syndrome), TTSC (through-the-scope clip)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 12, 2023
Accepted:
January 4,
2023
Received:
November 25,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
DISCLOSURE: All authors disclosed no financial relationships.
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy