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ABSTRACT
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.
Methods
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.
Results
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.
Conclusion
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.
Abbreviations:
ESD (endoscopic submucosal dissection), PECS (post-endoscopic submucosal dissection coagulation syndrome), TTSC (through-the-scope clips), OGM (origami method)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
January 4,
2023
Received in revised form:
December 31,
2022
Received:
November 25,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Author contributions: Kato M contributed to the conception and design, analysis, and interpretation of the data, drafting of the article, critical revision of the article for important intellectual content, and final approval of the article. Sasaki M, Iwata K, Miyazaki K, Kubosawa Y, Mizutani M, Takatori Y, Matsuura N, Nakayama A, Takabayashi K and Yahagi N contributed to critical revision of the article for important intellectual content and final approval of the article.
Funding: No financial support was received for this study.
Conflict of interest statement: There are no potential competing interests regarding this study.
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
