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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References
- Outcomes of endoscopic submucosal dissection for colorectal neoplasms: prospective, multicenter, cohort trial.Dig Endosc. 2022; 34: 1042-1051
- Effect of prophylactic closure on adverse events after colorectal endoscopic submucosal dissection: a meta-analysis.J Gastroenterol Hepatol. 2020; 35: 1869-1877
- Prophylactic clipping after colorectal endoscopic resection prevents bleeding of large, proximal polyps: meta-analysis of randomized trials.Gastroenterology. 2020; 159: 148-158
- Prophylactic clips to reduce delayed polypectomy bleeding after resection of large colorectal polyps: a systematic review and meta-analysis of randomized trials.Gastrointest Endosc. 2021; 93: 807-815
- Line-assisted complete closure for a large mucosal defect after colorectal endoscopic submucosal dissection decreased post-electrocoagulation syndrome.Dig Endosc. 2018; 30: 633-641
- Clip closure after resection of large colorectal lesions with substantial risk of bleeding.Gastroenterology. 2019; 157: 1213-1221
- Clip closure prevents bleeding after endoscopic resection of large colon polyps in a randomized trial.Gastroenterology. 2019; 157: 977-984
- In vitro comparison and evaluation of seven gastric closure modalities for natural orifice transluminal endoscopic surgery (NOTES).Endoscopy. 2008; 40: 595-601
- Comparison of endoscopic closure modalities for standardized colonic perforations in a porcine colon model.Endoscopy. 2011; 43: 217-222
- A simple novel endoscopic successive suture device: a validation study for closure strength and reproducibility.Endoscopy. 2013; 45: 655-660
- The efficacy and safety of prophylactic closure for a large mucosal defect after colorectal endoscopic submucosal dissection.Oncol Rep. 2013; 30: 85-90
- Feasibility of endoscopic suturing to prevent adverse events and hospitalization after endoscopic submucosal dissection.Endosc Int Open. 2020; 8: E1212-E1217
- Endoscopic double-layered suturing: a novel technique for closure of large mucosal defects after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD).Endoscopy. 2012; 44: E153-E154
- Feasibility of endoscopic mucosa-submucosa clip closure method (with video).Endosc Int Open. 2018; 6: E1070-E1074
- Injury to the muscle layer, increasing the risk of post-colorectal endoscopic submucosal dissection electrocoagulation syndrome.J Gastroenterol Hepatol. 2023; 38: 87-93
- Features of electrocoagulation syndrome after endoscopic submucosal dissection for colorectal neoplasm.J Gastroenterol Hepatol. 2016; 31: 615-620
- New closure technique for large mucosal defects after endoscopic submucosal dissection of colorectal tumors (with video).Gastrointest Endosc. 2012; 75: 663-667
- "Hold-and-drag" closure technique using repositionable clips for large mucosal defects after colonic endoscopic submucosal dissection.Endosc Int Open. 2016; 4: E1068-E1072
- Clip-on-clip closure method for a mucosal defect after colorectal endoscopic submucosal dissection: a prospective feasibility study.Surg Endosc. 2020; 34: 1412-1416
- Feasibility of underwater clip closure for large mucosal defects after colorectal endoscopic submucosal dissection.Digestion. 2019; 99: 327-332
- 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).Gastrointest Endosc. 2020; 92: 415-421
- New closure method using loop and open-close clips after endoscopic submucosal dissection of stomach and colon lesions.J Clin Med. 2021; 10: 3260
- Endoscopic slip-knot clip suturing method: prospective pilot study (with video).Gastrointest Endosc. 2017; 85: 433-437
- A novel endoloop system for closure of colonic mucosal defects through a single-channel colonoscope.Endoscopy. 2017; 49: 803-807
- Closure of large mucosal defects for prevention of strictures after duodenal endoscopic submucosal dissection (with video).Gastrointest Endosc. 2023; 97: 484-492
- 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
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
